ObjectiveTo compare the prevalence of asthma and the impact of socioeconomic position (SEP) on economic burden of asthma among rural residents in Yunnan province in 2011 and 2021, and to provide evidence for the prevention and treatment of asthma in the population. MethodsUsing stratified multistage random sampling, we conducted face-to-face surveys during 2011 and 2021 among 8 187 and 7 572 rural residents aged ≥ 35 years in Yunnan province. A self-designed questionnaire was used to collect information on demographics, SEP, asthma clinically diagnosed at township and upper level hospitals, and asthma-related economic burden for analyses on asthma prevalence and the influence of SEP on asthma-induced economic burden among the participants. ResultsAmong the rural adults surveyed in 2011 and 2021, totally 111 and 122 asthma cases were identified, with the asthma prevalence rate of 1.36% and 1.61% and without significant difference between the two prevalence rates. Compared to those reported by the adults with asthma incidence in 2011, significantly higher per capita asthma-related direct cost (4 230.11 vs. 2 776.85 Chinese Yuan), indirect cost (69.57 vs. 49.86), and total cost (4 299.68 vs. 2826.71) were reported by the adults with asthma incidence in 2021 (all P < 0.05). Contrasting to that in 2011, the per capita asthma-related total cost increased significantly in 2021 for the asthma sufferers of various SEP groups (P < 0.05 for all) and the total cost increment varied in a descending order for the asthma sufferers with high, low, lower-middle, and upper-middle SEP. Conclusion Among the rural adult residents in Yunnan province, the prevalence of asthma was not significantly different but the economic burden of asthma sufferers increased substantially between 2011 and 2022 and the sufferers' economic burden varied with their socioeconomic position.

Objective:To analyze the economic burden of asthma and associated factors in rural Yunnan Province.Methods:This study was a cross-sectional study.The multi-stage stratified random sampling method was used to select 7572 rural residents aged ≥35 years for on-site questionnaires and physical examinations in Yunnan Province.Two-step model and human capital method was used to estimate the direct and indirect costs of asthma, respectively, and T structural equation model was applied to analyze the possible influencing factors on costs of asthma.Results:The prevalence of asthma in rural Yunnan was 1.61%(122 cases), with 1.98%(74 cases) in males and 1.25%(48 cases) in females.The mean unit cost of asthma was estimated to be 4299.68 Yuan (RMB), with the direct cost 4230.11 Yuan (RMB), accounting for 98.38%, and indirect costs 69.57 Yuan (RMB), accounting for 1.62%.Hospitalization cost was the main economic burden of asthma, accounting for 50.27%.The results of structural equation modeling indicated that the top two factors on economic burden of asthma was length of hospital stay and level of hospital institutions, with the standardized regression coefficient of 0.65 and 0.61, respectively, followed by smoking, number of outpatient visits within one year, and central obesity, with the standardized regression coefficient of 0.22, 0.17, and 0.17, respectively.Conclusions:Reducing the length of hospital stay and lowering the level of hospital institutions, as well as enhancing health management of smokers and centrally obese persons among asthma patients, can effectively alleviate the economic burden of asthma in rural Yunnan province.

目的 了解云南省农村高血压患者的疾病经济负担及影响因素,为相关部门合理调整当地高血压防控策略,减轻高血压患者的疾病经济负担提供参考依据.方法 于2020年11月-2021年11月采用多阶段分层随机抽样的方法,在云南省农村地区抽取7 572名≥35岁常住居民为研究对象,进行问卷调查(包括一般人口学特征,高血压患病情况、诊疗情况以及因患高血压产生的费用支出)和体格检查.采用SPSS 24.0软件进行统计学分析,采用二步模型法测算高血压患者的直接疾病经济负担,采用人力资本法测算间接疾病经济负担,并用Amos 24.0构建结构方程模型分析其影响因素.结果 调查人群高血压患病率为41.57％,其中男性44.48％,女性38.74％.高血压患者的人均疾病经济负担为14 479.67元,其中人均直接经济负担为14 164.85元,人均间接经济负担为314.82元.在直接疾病经济负担中,人均住院费、门诊费、药费和交通及住宿费分别为10 736.36、1 473.53、1 606.53和348.43元,以住院费为主(占75.8％).结构方程模型分析结果显示,高血压患者的人口学特征、住院情况、误工情况、1年内门诊次数对疾病经济负担均有影响,其标准化路径系数分别为0.10、0.69、0.69和0.10.其中,以住院情况和误工情况对高血压疾病经济负担直接影响最大.结论 云南省农村高血压患者患病率较高,疾病经济负担较重,降低患者住院机构的级别和减少患者的住院天数有助于减轻其疾病经济负担.

目的 分析云南省农村居民慢性阻塞性肺疾病(chronic obstructive pulmonary dis-ease,COPD)患病现况及其影响因素.方法 采用多阶段分层随机抽样方法抽取云南省农村地区7 572名≥35岁常住居民进行现场问卷调查和体格检查,采用主成分分析法(principal compo-nent analysis,PCA)构建个体社会经济地位(socioeconomic status,SES),运用结构方程模型(structure equation modeling,SEM)分析COPD患病的影响因素.结果 云南省农村居民COPD患病率为12.60％,男性患病率高于女性(x2=57.973,P＜0.001);COPD患病率随年龄的增加而升高(x2趋势=165.616,P＜0.001);少数民族居民COPD患病率高于汉族居民(x2=33.785,P＜0.001);SES越低,COPD患病率越高(x2趋势＝10.751,P＜0.001).SEM分析结果显示,性别、年龄、民族和SES对COPD患病具有直接和间接作用,其总路径系数分别为0.09、0.15、0.06和-0.05,而COPD家族史、低BMI、现在吸烟和被动吸烟对COPD患病只有直接作用,其路径系数分别为0.06、0.03、0.08和0.08.结论 云南省农村居民COPD患病率较高,应加强对男性、高龄、吸烟、低BMI、有COPD家族史和SES较低人群的COPD健康教育和干预工作.

目的 分析云南省农村居民支气管哮喘(以下简称哮喘)的患病现状及社会人口学和生活行为影响因素.方法 采用多阶段分层随机抽样方法抽取云南农村地区7572名≥35岁农村居民进行现场问卷调查,采用结构方程模型(structural equation model,SEM)分析哮喘患病的相关影响因素.结果 云南省农村居民的哮喘患病率为1.61％,其中男性的患病率高于女性(1.98％和1.25％,χ2=6.308,P=0.012),且呈现随年龄的增加而升高的趋势(χ2趋势=65.558,P<0.001).SEM分析结果显示,吸烟者、被动吸烟者、有哮喘家族史者、男性、少数民族和住房类型为石头土坯者患哮喘的风险增高;其中对哮喘患病直接影响作用最大的是吸烟,其标准化路径系数为0.15;其他影响因素作用大小依次为有哮喘家族史(0.13)、年龄(0.09)、被动吸烟(0.08)、性别(0.06)、民族(0.03)和住房类型(-0.02).结论 云南省农村居民的哮喘的患病率较高,社会人口学和生活行为因素均对哮喘的患病有影响.应加强对男性、高龄、有哮喘家族史人群的健康管理,改善住房条件较差人群的居住环境,并加大控烟工作力度,以降低哮喘的发生.

ObjectiveTo analyze the economic burden of patients with chronic obstructive pulmonary disease (COPD) and its influencing factors in rural regions of Yunnan province and to provide evidence for formulating health policies and measures to reduce the economic burden. MethodsFace-to-face interview with a self-designed questionnaire and lung function test were conducted among 7 704 permanent residents at ages of 35 years and above recruited using stratified multistage random sampling in rural regions of Yunnan province from November 2020 to November 2021. Both direct and indirect cost of COPD patients were estimated and the influencing factors of the cost were analyzed with structural equation modeling. ResultsAmong the 7 572 participants with complete information, 954 COPD patients were diagnosed, with a prevalence rate of 12.6%. The estimated average annual COPD-related expenditure per patient was 5 787.2 Yuan (RMB); in which, 98.50% (5 700.5 Yuan) and 1.50% (87.2 Yuan) was direct and indirect cost. For the direct expenditure, the cost of hospitalization, outpatient service, medication, and accommodation/transportation were 3 020.7, 1 189.1, 141 8.6, and 72.1 Yuan. The results of structural equation model analysis indicated that the COPD patients′ economic burden was associated with the condition of hospitalization, frequency of outpatient visits within one year and the impact of the disease on patients’ life and work, with the standardized regression coefficient of 0.43, 0.36 and 0.27. The standardized regression coefficient for the length of hospital stay and the type of medical institution were 0.41 and 0.40; while the standardized regression coefficient for the impact of the disease on daily work, housework and daily life was 0.26, 0.23 and 0.23, respectively. ConclusionThe economic burden of rural COPD patients is relatively high in Yunnan province. The study results suggest that early diagnosis and treatment of the disease, reducing duration of hospitalization and the level of medical institution providing hospitalization service could alleviate the economic burden of the rural COPD patients.

目的 探讨顺行阴式子宫肌瘤剔除术(VM)与腹腔镜下子宫肌瘤剔除术(LM)治疗子宫肌瘤(UM)患者的应用价值.方法 选取80例行手术治疗的UM患者,按照手术路径不同分为对照组与研究组,每组40例.对照组实施LM治疗,研究组实施顺行VM治疗.对比两组围术期相关指标、并发症、术后肌瘤残留、复发情况及月经恢复情况.结果 研究组手术时间、术后首次排气、首次排便时间及肠鸣音恢复时间均短于对照组,术中出血量少于对照组,差异有统计学意义(P＜0.05);两组肌瘤剔除个数比较,差异无统计学意义(P＞0.05).两组术后并发症发生率比较,差异无统计学意义(P＞0.05).研究组术后肌瘤残留率[5.00％(2/40)]、术后肌瘤复发率[0(0/40)]、月经恢复正常率[95.00％(38/40)]与对照组的[5.00％(2/40)、7.50％(3/40)、90.00％(36/40)]比较,差异无统计学意义(P＞0.05).结论 LM与顺行VM治疗UM中具有创伤小、残留率少、复发率及并发症发生率低等优势,均可促进患者月经恢复正常,但顺行式VM手术时间较短,术中出血量较少,患者术后胃肠功能可尽早恢复.

Objective To explore the significance of vaginal microecosystem in diagnosis of high-risk human papillomavirus (HPV) infection and cervical lesions.Methods A total of 622 women were selected from Department of Gynecology in Kunming Yan'an Hospital from January 2015 to March 2017,then vaginal microecosystem,cervical liquid-based cytology test,and HR-HPV test were carried out.Results Among the women,great and middle amount of lactobacillus was found in 380 women,and few amount or no lactobacillus was found in 242 women;522 women were found with vaginal cleaning degree 1-2,and 100 women were found with vaginal cleaning degree 3-4.The numbers of women with positive BV,candidiasis infection,and trichomonas infection were 76,84,and 2,respectively.The numbers of women with positive HPV 16,HPV 18,other 12 susbtypes of HPV were 68,0,and 138,respectively.The numbers of women with mixed infection,HPV infection,and non-HPV infection were 34,168,and 454,respectively.The results of follow-up showed that 458 women had normal cervix,and 154 women with cervical lesions.There were statistically significant differences in the proportions of lactobacillus infection,vagina cleaning degree,and candidiasis infection between the women with positive HPV and the women with negative HPV (P＜ 0.05).There were statistically significant differences in the proportions of lactobacillus infection,vagina cleaning degree,and candidiasis infection between the women with cervical lesions and the women with normal cervix (P＜0.05).Conclusion Lactobacillus is a protective factor of vaginal microecosystem,while vagina cleaning degree and candidiasis infection are dangerous factors,which can induce HPV infection and cervical lesions.

目的 探讨云南普通人群女性阴道微生态异常中细菌性阴道病(bacterial vaginosis,BV)、滴虫性阴道炎(trichomonas vaginitis,TV)、外阴阴道假丝酵母菌病(vulvovaginal candidiasis,VVC)、阴道清洁度降低(Ⅲ～Ⅳ)、pH值升高(pH＞4.5)与高危型人乳头瘤病毒(high-risk human papillomavirus,HR-HPV)感染的相关性.方法 采用横断面研究设计,研究对象招募于云南省新平县年龄为20～65岁的普通女性人群.纳入者按HR-HPV感染情况分组,组间率比较采用x2检验,单因素分析采用logistic回归,进而分析上述阴道微生态异常与HR-HPV感染的相关性.结果 人组研究对象HR-HPV阳性率为5.7％(28/491),BV、TV、VVC、清洁度Ⅲ～Ⅳ及pH值＞4.5在HR-HPV阳性组中的发生率分别为28.6％(8/28)、10.7％(3/28)、10.7％(3/28)、21.4％ (6/28)、78.6％(22/28);在HR-HPV阴性组中发生率分别为16.4％ (76/463)、0.6％(3/463)、15.3％(71/463)、7.1％(33/463)和58.5％(271/463).TV、清洁度Ⅲ～Ⅳ、pH＞4.5在HR-HPV阳性组中发生率较高,且差异具有统计学意义(均P＜ 0.05),OR值及95％CI分别为18.400(3.533～95.822)、3.554(1.348～9.371)、2.598(1.034～6.528).而BV及VVC在两组中分布差异无统计学意义.结论 云南普通人群女性HR-HPV感染率较低;TV、清洁度Ⅲ～Ⅳ、pH＞4.5可能与HPV感染存在相关性.

Objective To analyze vaginal infection situations and risk factors among health screening Han nationality women in Kunming area and health screening Wa nationality women in Cangyuan area.Methods A one-to-one interview was performed for cross-sectional epidemiological investigation,the questionnaire content included occupation,educational level,living conditions,the types of bathroom,washing and bathing ways,smoking,alcohol consumption,the number of sexual partners,vaginal washing or not and the frequency,history of marriage,health behaviors and habits.Vaginal cleanliness,pH value,trichomonad,candida,clue cells,leptotrichia,and Gartner bacteria in vaginal secretions were detected.Results There were statistically significant differences in occupation,washing and bathing ways,educational level,single separate bathroom,the number of sexual partners,vaginal washing habit,delivery mode,and the number of term delivery between Han nationality women in Kunming area and Wa nationality women in Cangyuan area (P＜0.05);there was no statistically significant difference in smoking and alcohol consumption between Han nationality women in Kunming area and Wa nationality women in Cangyuan area (P＞0.05).There were statistically significant differences in the detection rates of Candida,trichomonad,leptotrichia,neuraminidase,and β-glucuronidase between Han nationality women in Kunming area and Wa nationality women in Cangyuan area (P＜ 0.05);there was no statistically significant difference in vaginal cleanliness,pH value,hydrogen peroxide,the detection rates of clue cells,Gartner bacteria,leucocyte esterase,and coagulase between Han nationality women in Kunming area and Wa nationality women in Cangyuan area (P＞0.05).There was no statistically significant difference in micro-ecological anomaly and incidence rate of bacterial vaginosis between Han nationality women in Kunming area and Wa nationality women in Cangyuan area (P＞0.05).There were statistically significant differences in the incidence rates of trichomonas vaginitis and vulvovaginal candidiasis between Han nationality women in Kunming area and Wa nationality women in Cangyuan area (P＜0.05).Conclusion The incidence rates of trichomonas vaginitis and vulvovaginal candidiasis among Wa nationality women in Cangyuan area are significantly higher than those among Han nationality women in Kunming area,which are correlated with more farming population,lower educational level,lack of bathing facilities and hygiene habits,multiple sexual partners,and multiple natural labor among Wa nationality women in Cangyuan area.

随着社会各界对妇女、儿童健康的日益关注,剖宫产的研究一直备受医学界关注.事实剖宫产的高低是衡量一个国家或地区围产水平、科技水平和人口素质高低的重要指标,大量研究表明过高的剖宫产率伴随母儿远、近期并发症的增加,基于此,WHO曾于1985年提出剖宫产率不应超过15％[1].

卵巢早衰是妇科内分泌的常见病,导致40岁以前的妇女出现闭经、不孕、潮热多汗、性欲低下为主要特征的围绝经期症状.卵巢早衰严重影响了患者的身体健康和生活质量.所以POF需早发现、早诊断,早预测.目前主要治疗方法是激素替代疗法缓解绝经症状以及辅助生殖技术解决生殖问题,基因治疗、干细胞治疗、卵巢移植技术给患者带来希望.面对POF患者应采取积极的医疗行为-心理指导-社会生活综合治疗,提供科学的预防措施,并对其进行按期随访和关爱.

目的 了解西双版纳州农村傣族妇女阴道微生态状况并分析相关影响因素,为临床预防和控制妇女阴道菌群失衡提供依据.方法 选取西双版纳傣族自治州大勐龙镇4个自然村的202名已婚傣族妇女作为研究对象,将同期体检的200名景洪市女职工作对照.常规妇检采集阴道侧穹窿上1/3分泌物,进行阴道微生态检测及相关因素分析.结果 202名傣族农村妇女阴道微生态正常者36例,占17.82％,阴道微生态失调166例,占82.18％;200名景洪市体检妇女微生态正常者106例,占53.00％,阴道微生态失调94例,占47.00％,经比较差异有统计学意义(P＜0.05).结论 农村妇女阴道微生态状况较城市人群差,应加强对农村妇女的健康知识的普及,改善生殖健康.

Objective To learn the vaginal microecological status of rural minority women in Nujiang,Yunnan to promote reproductive health education.Methods 106 rural women of ethnic minority from 3natural villages in Nujiang,Yunnan were selected as the subjects,with 120 healthy women from Kunming as the controls.Vaginal discharges were collected to detect the H2O2 content with conventional gynecological examination method;Gram staining was conducted for vaginal micro-ecological evaluation(including density and diversity of vaginal flora and inflammatory reaction).Results Of the 106 subjects,19cases(17.92%)had normal vaginal flora,while 87cases(82.07%)had vaginal microecological imbalance(abnormal flora,bacteria inhibition and excessive bacteria proliferation);The detection rate of lactic acid bacteria was16.04%.In contrast,there were 70cases(58.33%)of normal microecology and 50cases(41.66%)of vaginal microecological imbalance in the 120 healthy women;The detection rate of lactic acid bacteria 59.17%,significantly different from that of the rural minority subjects(P0.05).Conclusion The vaginal microecological status of the rural minority women in Nujiang of Yunnan province is inferior to that of the urban population.Education of reproductive health knowledge should be further strengthened in rural minority region of Yunnan to help improve the reproductive health status of the local women.

月经过多是指月经血量大于80ml,其周期是规律的,出血来自分泌期子宫内膜,特征月经失血量超过80ml,子宫大小正常或者稍微变大,没有发现导致其严重出血的原因.对于月经过多的患者,我们在临床工作中一般首选的治疗方案时让患者服用性激素类药物,虽然在一定程度上能够达到治疗的目的,但是患者有时需要长期服药,一旦停药则容易复发,而长期的口服药物会带来许多问题和不良反应,使得患者的服药依从性下降,久而久之,患者为了彻底地治疗病情,可能会选择子宫切除或子宫内膜去除术,对患者的健康和生活造成严重的影响.而我们在临床应用中发现,曼月乐对于治疗月经过多和痛经能够取得良好的治疗效果,现报告如下.

目的 分析云南沧源县8个乡镇不同年龄佤族妇女阴道微生态环境的变化规律.方法 用革兰染色法、生化五联法检测以及阴道pH试纸联合对763例佤族妇女的阴道分泌物状态检测.结果 763例受检妇女阴道分泌物中微生态异常比率为50.72％,微生态异常集中在31～50岁妇女中,在31～40岁中最高,假丝酵母菌阴道炎、滴虫性阴道病集中在31～50岁妇女中,而细菌性阴道炎集中在40岁以下妇女,需氧菌性阴道炎高发于31～40岁组中,差异有统计学意义.结论 沧源县8个乡镇佤族妇女的阴道微生态失调基本与年龄分布一致,呈正态分布,育龄妇女(尤其是31～40岁)为阴道炎好发年龄组.

Objective To study the clinical effects of estradiol valerate united carboprost in the removal of intrauterine device(IUD) in postmenopausal women. Methods 174 postmenopausal women for removal of IUD were collected form Yan’an Hospital of Kunming City from 2010-10 to 2012-10. All of them were divided into study group and control group, 87 cases for each. The study group was given estradiol valerate 5 days before the operation and 1mg carboprost had been placed in posterior fornix of vagina 1 hour before the operation. The control group had not been given any treatments. Evaluate the degree of cervical softening and the success ratio of removal of IUD between the two groups. Results The cervical softening rate of the study group was 94.32% and the success ratio of removal of IUD was 97.72%, while the success ratio of removal of IUD of the control group was 75.00%. Conclusion The success ratio of removal of IUD was 97.72%when estradiol valerate combined carboprost were used in postmenopausal women. It can effectively alleviate the suffering of the patients, make the operation easier and less side effects, is worth for clinical application.

目的:探讨释放左炔诺孕酮宫内缓释系统(曼月乐)治疗月经过多的疗效和安全性.方法:50例月经过多患者放置曼月乐后进行12个月的随访.在放置前、放置后1个月、3个月、6个月、12个月分析患者月经量.结果:子宫内膜变薄(P＜0.01),子宫体积略缩小.结论:它对月经过多的治疗安全有效,是一种较理想的保守性治疗手段.

目的:探究系统性红斑狼疮并发细菌及真菌感染的临床特点.方法:选取SLE并发真菌、细菌感染患者46例,对患者的临床治疗资料进行分析.结果:46例患者感染61例次,其中格兰阴性杆菌感染33例次,革兰阳性球菌感染20例次,真菌感染8例次;共有57个部位发生感染,其中呼吸道感染34例,泌尿系统感染9例,皮肤感染7例,胃肠感染4例,中枢神经感染2例,关节感染1例.结论:SLE期间并发真菌、细菌感染患者常为院内感染,且多数为格兰仕阴性杆菌感染,革掌握易感菌种及部位,采取针对性的防治措施是保障患者早日康复的关键.

痛风石是痛风的特征性病变,痛风石形成的典型部位在耳轮,也常见于第一跖趾、指间、踝、腕、膝、肘等处,发生在脊柱部位的痛风石极为少见,我院近期收治1例腰椎痛风石患者,现报道如下: