目前,国内尚无关于九价人乳头瘤病毒疫苗导致药物性肝损伤的报道,但这一问题应引起临床医师的高度重视。现报道1例中年女性患者,在接种九价HPV疫苗第二针后出现乏力、纳差、巩膜及皮肤黄染,经护肝、利胆等对症支持治疗后症状好转,但临床医生未能及时说服患者完善相关检查进一步排查药物性肝损伤,致患者继续接种第三针,出现肝损慢性化、严重化。经进一步的护肝、利胆、营养支持等对症支持治疗并随访5个月,患者肝脏功能已恢复正常。通过该病例以期提高临床对药物性肝损伤的认知及诊治水平。At present, there is no report on drug-induced liver injury caused by nine-valent human papillomavirus vaccine in China, but this problem should be highly valued by clinicians. It is reported that a middle-aged female patient suffered from fatigue, poor appetite, yellow staining of sclera and skin after the second dose of nine-valent HPV vaccine. After symptomatic support treatment such as protecting the liver and promoting gallbladder function, the symptoms improved, but the clinician failed to persuade the patient to improve the relevant examination in time to further investigate the drug-induced liver injury, resulting in the patient continuing to receive the third dose, resulting in chronic and severe liver damage. After further symptomatic support treatment such as liver protection, choleretic and nutritional support and follow-up for 5 months, the liver function of the patient has returned to normal. Through this case, we hope to improve the clinical cognition, diagnosis and treatment of drug-induced liver injury.
原发性胆汁性肝硬化(Primary Biliary Cholangitis, PBC)和自身免疫性肝炎(Autoimmune Hepatitis, AIH)是不同的自身免疫性慢性肝病,这2种疾病在同一患者中共存称为重叠综合征。干燥综合征(Sjögren Syndrome, SS)是自身免疫性肝病(Autoimmune Liver Disease, AILD)最常并发的肝外自身免疫病。本文报告了一例AIH-PBC重叠综合征合并SS的病例,探讨其临床表现、诊断和治疗策略。Autoimmune hepatitis (AIH) and primary biliary cholangitis (PBC) are two common clinical autoimmune liver diseases, and some patients have both diseases;this feature is called AIH-PBC overlap syndrome. Sjögren syndrome is one of the most common extrahepatic autoimmune diseases among patients with autoimmune liver diseases. This article presents the case report of an elderly female patient who was diagnosed with AIH-PBC overlap syndrome combined with Sjögren syndrome, and discusses its clinical presentation, diagnosis and treatment strategies.
1例以腹泻为主要表现的肠气囊肿症(pneumatosis cystoides intestinalis, PCI)患者,患者既往糖尿病20余年,一直在规律服用“阿卡波糖”降糖治疗,完善腹部影像学及内镜检查后明确诊断为肠气囊肿症。采用调整降糖方案、高压氧疗2次/天(共5天)、抑酸保护胃黏膜、调节肠道菌群等支持治疗后患者腹泻、腹痛好转。半年后返院复查肠镜未见异常。肠气囊肿症是临床上一种少见的疾病,其临床表现多样,无特异性,为提高临床医生对本病的认识水平,笔者总结了1例以腹泻为主要表现的肠气囊肿症的诊治经过,现报道如下。A patient with diarrhea as the main manifestation of pneumatosis cystoides intestinalis (PCI), who has had diabetes for more than 20 years, has been taking acarbose as hypoglycemic therapy regularly. She was diagnosed with pneumatosis cystoides intestinalis after abdominal imaging and endoscopic examination. The patient’s diarrhea and abdominal pain were improved after treatment with adjusted hypoglycemic regimen, hyperbaric oxygen therapy twice a day (5 days in total), acid inhibition to protect gastric mucosa, and regulation of intestinal flora. Six months later, she returned to the hospital and rechecked the colonoscopy. Pneumatosis cystoides intestinalis is a rare disease in the clinic, and its clinical manifestations are diverse and non-specific. In order to improve the understanding level of clinicians, the author summarized the diagnosis and treatment of 1 case of pneumatosis cystoides intestinalis with diarrhea as the main manifestation, and reported as follows.
血脑屏障(blood brain barrier, BBB)是存在于外周血液和脑组织之间的结构,保护大脑免受内源性及外源性毒素和病原体的侵害,从而维持脑内环境稳定。在中枢神经系统疾病中,血脑屏障的破坏将进一步加剧疾病的进展。研究表明血小板源性生长因子(platelet-derived growth factor, PDGF)在血脑屏障的形成及功能维持中发挥重要作用,本文总结了PDGF及其受体在生理及病理情况下对血脑屏障的影响,初步探讨PDGF在中枢神经系统疾病中的治疗可能性,并对当前靶向PDGF及其受体的治疗手段进行简要综述。The blood brain barrier (BBB) is a structure that exists between peripheral blood and brain tissue, protecting the brain from endogenous and exogenous toxins and pathogens, thereby maintaining the stability of the brain internal environment. In central nervous system diseases, the disruption of BBB further exacerbates disease progression. Compelling data indicates that platelet-derived growth factor (PDGF) plays an important role in the maintenance and formation of BBB. This article summarizes the effects of PDGFs and their receptors on the integrity of BBB under physiological and pathological conditions. Finally, we briefly summarize the potential therapeutic strategy of PDGFs in central nervous system diseases, and review the current therapeutic methods targeting PDGFR.
报道一例以共济失调、全身震颤、眼肌麻痹、痉挛性截瘫为临床表现的成人起病的常染色体隐性遗传的复杂型遗传性痉挛性截瘫(hereditary spastic paraplegias, HSP)。患者通过全外显子基因测序,找到DDHD2基因[c.335G>A, p.R112Q]的纯合突变,提示该突变可能与该患者的临床表现相关。本例报告为复杂型HSP的遗传基础提供了新的见解,并强调了基因检测在此类罕见疾病诊断中的重要性。We report a case of adult-onset autosomal recessive complex hereditary spastic paraplegia (HSP), characterized by a combination of ataxia, generalized tremor, ophthalmoplegia, and spastic paraplegia. Genetic analysis through whole-exome sequencing identified a homozygous mutation in the DDHD2 gene (c.335G>A, p.R112Q), which is likely responsible for the observed clinical manifestations. This case report provides new insights into the genetic basis of complex HSP and highlights the importance of genetic testing in the diagnosis of such rare diseases.
暂无评论