目的 比较研究颞下颌关节紊乱病(temporomandibular disorders,TMD)单侧颞下颌关节疼痛患者与夜磨牙患者的咬合关系特点,为临床鉴别诊断及治疗方案的设计提供参考依据.方法 选取2015-2017年于空军军医大学第三附属医院颞下颌关节病科就诊的169例TMD单侧颞下颌关节疼痛患者(TMD组)和189例夜磨牙患者(夜磨牙组)的临床资料进行回顾性分析.对2组患者治疗前牙颌石膏模型进行测量分析,比较其错畸形分类、上下牙列中线位置、前牙覆和覆盖情况、个别牙错、个别牙错位、缺牙(第三磨牙除外)、第三磨牙萌出及口腔修复情况.结果 ①2组患者错畸形分类、上下牙列中线位置、前牙覆覆盖情况比较,差异均无统计学意义(均P＞0.05).②TMD组患者反发生率(28.4％)明显高于夜磨牙组(17.5％),差异有统计学意义(x2=6.102,P=0.014);而2组患者锁、对刃及开发生率比较,差异均无统计学意义(均P＞0.05).③TMD组上颌侧切牙伴其他牙位唇倾的占比(22.6％)明显高于夜磨牙组(4.9％),上颌中切牙伴其他牙位扭转的占比(53.3％)低于夜磨牙组(74.5％),而上颌尖牙伴其他牙位扭转的占比(37.8％)明显高于夜磨牙组(5.5％),差异均有统计学意义(均P＜0.05);而2组其他牙位错位情况比较,差异均无统计学意义(均P＞0.05).④TMD组缺牙发生率(23.7％)高于夜磨牙组(15.3％),差异有统计学意义(x2=3.974,P=0.046);在各组缺牙患者中,TMD组多颗牙缺失患者占比(47.5％)大于夜磨牙组(24.1％),夜磨牙组单颗牙缺失患者占比(75.9％)大于TMD组(52.5％),其分布差异有统计学意义(x2=3.907,P=0.048).⑤TMD组患者双侧下颌第三磨牙的萌出率均高于夜磨牙组,差异均有统计学意义(均P＜0.05);而2组上颌第三磨牙萌出率比较,差异无统计学意义(P＞0.05).⑥在各组固定义齿修复患者中,TMD组多颗修复患者占比(89.5％)大于夜磨牙组(占33.3％),夜磨牙组单颗修复患者占比(66.7％)大于TMD组(10.5％),其分布差异有统计学意义(P＜0.001).结论 TMD单侧颞下颌关节疼痛患者与夜磨牙患者的咬合特点在个别牙反、个别牙错位、缺牙(第三磨牙除外)、下颌第三磨牙萌出及口腔修复情况方面存在一定差异,可为临床鉴别诊断提供参考依据.

To conduct a comprehensive analysis of prospectively measuring the concentration of soluble suppression of tumorigenicity 2 (sST2) to predict left atrial (LA) low-voltage areas (LVAs) and atrial fibrillation (AF) recurrence after radiofrequency catheter ablation (RFA). This was a prospective cohort study. A total of 84 patients, including 54 paroxysmal AF cases and 30 persistent AF cases who underwent RFA, were recruited. Electroanatomical voltage mapping determined the extent of LVAs. The serum level of sST2 was measured by enzyme-linked immunosorbent assay. All patients were followed for 12 months after the RFA procedure to verify AF recurrence. The concentration of sST2 measured in the sample was 17.90–198.77 pg/mL, and the range of LA LVAs was 0–85.6%. The sST2 level positively correlated with LVAs (r = 0.40; P = 0.005). When comparing the top and bottom quartile, sST2 is significantly associated with LA LVAs (OR = 1.833, 95% CI: 1.582–2.011, P = 0.004). When compared with the 1st quartile group, the multivariable adjusted hazard ratios for AF recurrence after RFA were 1.57 (95% CI: 1.182–1.795) for the 4th quartile group, 1.44 (95% CI: 1.085–1.598) for the 3rd quartile group, and 1.27 (95% CI: 0.954–1.318) for the 2nd quartile group. The AF–free survival rates of patients with 1st quartile and 4th quartile sST2 levels after ablation were 95% and 59.6%, respectively (Log Rank test, P = 0.027). Elevated sST2 levels of AF patients were associated with higher LA LVAs and a significantly increased risk of recurrence. The circulating sST2 concentration might be a pre-diagnostic marker of AF recurrence after RFA.

目的:探究有局部义齿的颞下颌关节紊乱病(TMD)患者,其咬合与TMD症状及体征之间的关系.方法:共收集了口内有局部义齿的患者135例,其中75例有单侧颌面肌肉疼痛或单侧TMJ弹响等TMD症状,60例无TMD相关症状或体征.采用T检验对年龄(符合正态分布)进行比较,采用秩和检验对修复时间、修复体数量等不符合正态分布的参数数据进行比较;采用卡方检验对性别,修复体类型,以及前牙浅、中、深覆和浅、中、深覆盖的频数分布进行检验;分别采用单因素和多因素二元logistic回归模型进行分析,其中无症状组赋值为0,患者组赋值为1,共统计了 13个变量,包括性别、年龄、修复体数量、修复体象限的数量、修复体在上下颌及前牙后牙的位置、有无上下颌成对的修复体、前牙覆、覆盖情况等.结果:两组患者的性别、年龄、修复体的数量、位置、类型及修复时间等指标未见明显差别,两组具有较好的可比性.卡方检验表明,单侧TMD组前牙开、对刃、反等异常覆覆盖的频数明显多于对照组(P＜0.001,X2=20.064;P＜0.001,X2=21.691).单因素二元logistic回归分析结果显示,覆(OR=1.947)和上颌单侧后牙修复体(OR=6.000)为单侧TMD的危险因素(P＜0.05),此二因素且仅此二因素进入了多因素二元logistic回归模型,且前牙覆OR值从1.947升为2.972,上颌单侧后牙修复体的OR值从6.000升为11.450.结论:佩戴局部义齿者的前牙异常覆覆盖与单侧TMD症状关系密切;前牙深覆及单侧上颌后牙修复体是佩戴局部义齿者出现单侧TMD症状的危险因素,当二因素同时存在时,其出现单侧TMD的风险将进一步增加.

目的 探讨术前血清sST2浓度以及sST2联合左心房前后径(LAD)对心房颤动(房颤)射频消融术后复发的预测价值.方法 选取2020年2月至2020年10月间在西安交通大学第二附属医院心内科住院并且进行射频消融手术治疗的房颤患者84例,其中阵发性房颤57例,持续性房颤27例,男性48人,女性36人,平均年龄(64.24±10.17)岁.收集所有患者术前一般临床资料和血液学指标.采用ELISA法检测患者血清sST2浓度.心脏超声于收缩末期胸骨旁长轴切面测量LAD.所有入选的房颤患者于消融术后3、6、12月定期随访.采用单因素和多因素Cox回归分析sST2联合LAD对房颤术后复发的预测价值.结果 单因素及多因素Cox回归模型分析显示,血清sST2(HR=1.014,95％CI 0.986～1.035,P=0.035)、LAD (HR=1.271,95％CI 0.946～1.378,P=0.036)是影响房颤复发的独立危险因素.sST2联合LAD预测房颤复发的能力进一步提升,ROC曲线下面积为0.907,灵敏度0.846,特异度0.894.结论 术前检测血清sST2浓度以及sST2联合超声测量LAD可对房颤射频消融术后复发提供预测价值.

Objective:To explore the differences in imaging characteristics and risk factors for mortality between the young and middle-aged and elderly patients with aortic dissection.Methods:The data from 1 220 patients with aortic dissection from January 2007 to December 2015 were successively collected. They were divided into young and middle-aged and elderly groups according to their ages. The basic information, computer comography angiography and echocardiogram results, hospital admissions and surgical details were collected and compared between the two groups using single variable regression analysis.Results:The ratio of female patients in the middle-aged and elderly group (>45 years old) was significantly higher than that of the young group (≤45 years old) (24.9% vs 18.7%, P=0.014), the ratio of hypertension patients was also significantly higher than that in the young group (77.5% vs 68.1%, P<0.001). Echocardiographic parameters showed that the prevalences of left ventricular enlargement (39.9% vs 26.9%) and left ventricular dysfunction (22.3% vs 14.1%) in the young group were significantly higher than in the middle-aged and elderly group (all P<0.001). The prevalences of ascending aorta dilation [(43.04±9.12)mm vs (41.69±10.99)mm] and thrombosis (39.1% vs 28.5%) were higher ( P<0.05). Although there was no statistically significant difference in mortality within 60 days after admission between the two groups (12.0% vs 15.1%, P=0.164), univariate regression analysis showed that aortic branch involvement was the main independent risk factor for mortality in young patients. Left ventricular remodeling (left atrial enlargement, ascending aortic dilation, aortic regurgitation) and decreased heart function were the main independent risk factors for death in the elderly patients. Conclusions:The mortality rate of young and middle-aged and elderly patients with aortic dissection are comparable, but the influencing factors are different. Screening out the relevant risk factors that affect the survival rate of the two groups, and conducting targeted prevention and intervention on them areof great significance to improve the survival rate of patients.

目的 探讨主动脉夹层(AD)患者临床发病特征,分析重要脏器及血管受累情况以及患者预后(死亡)情况.方法 连续收集1 220例急性AD患者资料,对其临床发病特征、重要脏器及血管受累情况、预后(死亡)情况进行分析.结果 1 220例AD中,DeBakeyⅢ型占42.70％(521/1 220),其次为Ⅰ型(473/1 220,38.77％)和Ⅱ型(117/1 220,9.59％).颈部血管受累以DeBakey I型累及无名动脉最常见(183/271,67.53％);腹部血管和髂血管最高累及率分别为51.64％(221/428)和31.92％(151/473);心脏改变主要累及左心.术前凝血功能异常者占96.62％(1 003/1 038),术后肾功能异常者占57.14％(324/567).1 220例AD患者总死亡率为14.01％(171/1 220),术前死亡原因主要为夹层破裂(81/171,47.37％),术后死亡原因主要为多器官功能衰竭和心力衰竭心律失常(66/171,38.60％).结论 AD临床特征明显,多脏器功能衰竭是患者术后死亡的主要原因之一,临床诊治需综合考虑重要脏器受累对预后的影响.