椎-基底动脉显著扩张、延长、扭曲或成角被称为椎-基底动脉延长扩张症(vertebrobasilar dolicho-ectasia VBD),该疾病是一种血管异常性疾病,病因不明,临床少见,发病原因可能与高血压、抗凝药物及抗血小板药物的使用有关[1].随着多层螺旋 CT时间分辨率的提高、探测器宽度的增加,图像数据采集时间明显缩短,CT 头颈部动脉成像(CTA,angi-ography)越来越多地应用于临床[2-4].本研究旨在探讨 256 层螺旋 CT 头颈部 CTA 对椎基底动脉扩张延长症的诊断价值.

肝内胆管错构瘤无明显的临床症状,在常规超声检查中很容易漏诊误诊,了解该病的各种超声特点,有助于提高超声对该病诊断的准确性,减低误诊率.本文对超声易误诊肝内胆管错构瘤一例进行研究分析.

<正>脊髓亚急性联合变性(SCD)是由于维生素B12缺乏导致的神经系统变性疾病,病变主要累及脊髓后索、侧索及周围神经,临床表现为深感觉缺失、感觉性共济失调、痉挛性截瘫及周围神经病变等。由于SCD表现的多样性和非特异性,临床容易被误诊。

目的 通过观察川崎病(Kawasaki disease,KD)患儿外周血中性粒细胞中的中毒颗粒(toxic granu-lation, TG),探讨预测KD患儿预后的新指标.方法 对入院7 d内的KD患儿126例常规取血制片,瑞氏染色后观察中性粒细胞形态,根据TG所占比例分为TG阳性组和阴性组.比较两组之间的WBC计数、红细胞比积、血清白蛋白值、CRP、血沉以及冠状动脉损害(coronary artery lesion,CAL)的发生率和残存率.结果 TG阳性组白细胞数目、CRP值及血沉显著高于阴性组(P＜0.01),红细胞比积、血清白蛋白值明显低于阴性组(P＜0.01).TG阳性组的6个月后CAL残留率大于阴性组(P＜0.01).结论 TG有望成为预测KD预后的危险因素之一.

Aim To evaluate the long-term effects of lipoprotein (a) [Lp(a)] on the development of coronary atherosclerosis in Wahanabe heritable hyperlipidemic (WHHL) rabbits, to further study the mechanism of Lp(a) in the process of atherosclerosis. Methods Generated human apolipoprotein (a) [apo(a)] transgenic (Tg) WHHL rabbits were compared with non-Tg WHHL rabbits aged 24 months (fed a standard chow diet). Plasma levels of Lp (a), total cholesterol (TC), triglyceride (TG), high density lipoproteins cholosterol (HDLC) and plasma levels of C-reactive protein (CRP) were measured using the methods. Area of intimal lesion and stenosis degree were measured by histologically staining and the components in the lesions were analyzed using immunohistochemical staining. Result The mean levels of human Lp(a) in Tg rabbit plasma were 9.1±3.5 nmol/L at 24 months. Compared to non-Tg WHHL rabbits, Tg WHHL rabbits did not show significant changes in plasma TC, TG, or HDLC. However, Tg WHHL rabbits showed 3.5-fold increased lesions in right coronary arteries than non-Tg WHHL rabbits (P<0.05). Increased lesion size in RCA of Tg WHHL rabbits did not result in a proportional increase of lumen stenosis in RCA (26.9±6.6% in non-Tg vs 27.7±5.0% in Tg), suggesting that compensational remodeling occurred as the diameter of RCA of Tg WHHL rabbits were markedly increased (1.8±0.6 mm2 in non-Tg vs 5.3±1.1 mm2 in Tg, P<0.05). Human apo (a) immuno-reactive proteins were focally present in the lesions of Tg WHHL rabbits and associated with apolipoprotein B, but mainly located around the extracellular matrix rather than associated with macrophages. Cellular components accounted for less than 10% of the lesions and there were no difference between non-Tg and Tg WHHL rabbits. Three Tg rabbits (33%) and one non-Tg WHHL rabbits (9%) which had apparently extensive myocardial infarction lesions were detected. Conclusion Increased plasma levels of Lp (a) enhance the coronary atherosclerosis in the setting of hypercholesterolemia.

心肌炎是儿童时期常见的心血管疾病,近年来发病有增多趋势,其病原呈多种多样,国内统计虽以病毒性为多,但也有其他微生物引起心肌炎的可能.肺炎衣原体( C.pn)广泛存在,主要引起呼吸系统感染,还与心肌炎、脑炎、甲状腺炎、红斑结节等呼吸系统以外的疾病有关.为了解 C.pn感染与小儿心肌炎间的关系,探讨心肌炎患儿 C.pn感染的诊断及治疗,我们对 50例心肌炎患儿及 30例非感染对照组进行 C.pn检测,现报道如下.

目的:探讨肺炎支原体引起心肌损害的发病情况.方法:对诊断为肺炎支原体感染的患儿必要时做心肌酶谱及心电图等检查,以了解心肌损害的程度并给予相应治疗.结果:其中心肌受累者42例,占肺炎支原体感染的13.2%,42例均有心肌酶谱改变,38例有不同程度的心电图改变,经抗肺炎支原体及营养心肌等综合治疗4～6周,除了4例心电图未恢复外,其他患儿均治愈.结论:本文肺炎支原体感染中心肌受累者发病率较既往文献报道为高,且部分患儿临床缺乏心脏受累症状,故我们认为对肺炎支原体感染患儿应常规行心肌酶谱及心电图检查,以免贻误病情.

过敏性紫癜(AP)是儿童常见的出血性疾病,常有多器官受累,可并发心肌损害而出现心肌酶及心电图改变.现对1998年2月～2002年2月我院收治的97例AP患儿中,出现高度房室传导阻滞12例,进行心肌酶及心电图变化的分析,报道如下.

结核性脑膜炎是小儿结核病中最严重的病型,常在初染后1年内发病.

小儿病毒性心肌炎近年来发病有增多趋势,心电图(ECG)检查是心肌炎诊断中不可缺少的资料,而Holter(24 h动态心电图)监测与常规ECG相比能获得更多可靠完整的资料,目前已成为心血管领域中无创伤检查的重要方法之一.本文就我院1998～2001年126例诊断为病毒性心肌炎或疑似心肌炎患儿,全部行ECG与Holter检查,并对比分析,以探讨后者对心肌炎的诊断价值.