目的了解原发性痛风的临床特点,分析与其相关的高危因素,为临床诊断以及预防痛风提供参考。方法回顾性分析195例初诊的原发性痛风患者的一般情况、生活方式、临床资料,以及实验室检查结果,并对原发性痛风发生的危险因素进行分析。结果 195例中,男性占97.4%(190/195),发病高峰在40～60岁(54.9%,107/195)。最常见的首发部位为第一跖趾关节,占86.2%(168/195)。单因素Logistic回归分析显示:(1)原发性痛风的发生与高嘌呤饮食相关,与吸烟、饮酒无关,若患者生活中既饮酒又吸烟,痛风发生的危险性将明显增高;(2)高体质指数(body mass index,BMI)、高血压、高血压家族史、冠心病家族史为原发性痛风的高危因素;(3)血脂组中:除载脂蛋白A(Apo-A)外,其余指标均与原发性痛风相关。三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白B(Apo-B)浓度的升高,高密度脂蛋白胆固醇(HDL-C)浓度的降低为痛风发病的高危因素。血清尿酸清除分数(FEuA)降低是痛风发生的独立危险因素。结论中老年男性原发性痛风的发病率较高,原发性痛风的危险因素包括:高嘌呤饮食,饮酒合并吸烟,高BMI、高血压、高血压家族史、冠心病家族史,高血脂等。中国人存在多种原发痛风的危险因素,应早期预防。
目的分析心理社会因素对冠心病发生、发展的影响。方法采用多种心理量表对54例冠心病患者和48例健康志愿者进行对照研究。结果两组SCL-90量表结果显示冠心病组抑郁发生率高于对照组(56% vs 8.3%),P<0.05,提示冠心病患者伴有较高的忧郁症状,冠心病组焦虑发生率高于对照组(67% vs 8.3%),P<0.05,提示冠心病患者伴有较高的焦虑症状;两组生活事件数及其刺激量表比较,P<0.05,提示冠心病患者常采用不成熟的应对方式对付生活事件,患病前所经历的负性生活事件数量明显增多。结论心理健康状况与冠心病有密切关系,及时有效地实施负性情绪干预对冠心病患者康复起着重要的作用。
Parkinson’s disease （PD） is caused by progressive degeneration of dopamine （DA） neurons in the substantia nigra pars compacta （SNpc）, resulting in the deficiency of DA in the striatum. Thus, symptoms are developed, such as akinesia, rigidity and tremor. The aetiology of neuronal death in PD still remains unclear. Several possible mechanisms of the degeneration of dopaminergic neurons are still elusive. Various mechanisms of neuronal degeneration in PD have been proposed, including formation of free radicals, oxidative stress, mitochondrial dysfunction, excitotoxicity, calcium cytotoxicity, trophic factor deficiency, inflammatory processes, genetic factors, environmental factors, toxic action of nitric oxide, and apoptosis. All these factors interact with each other, inducing a vicious cycle of toxicity causing neuronal dysfunction, atrophy and finally cell death. Considerable evidence suggests that free radicals and oxidative stress may play key roles in the pathogenesis of PD. However, currently, drug therapy cannot completely cure the disease. DA replacement therapy with levodopa （L-Dopa）, although still being a gold standard for symptomatic treatment of PD, only alleviates the clinical symptoms. Furthermore, patients usually experience severe side effects several years after the L-Dopa treatment. Until now, no therapy is available to stop or at least slow down the neurodegeneration in patients. Therefore, efforts are made not only to improve the effect of L-Dopa treatment for PD, but also to investigate new drugs with both antiparkinsonian and neuroprotective effects. Here, the advantages and limitations of current and future therapies for PD were dicussed. Current therapies include dopaminergic therapy, DA agonists, MAO-B inhibitor, COMT inhibitors, anticholinergic drugs, surgical procedures such as pallidotomy and more specifically deep brain stimulation of the globus pallidus pars interna （GPi） or subthalamic nucleus （STN）, and stem cell transplantation.
