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《医学前沿（英文）》 2017年第11卷第3期页码 340-348 doi: 10.1007/s11684-017-0570-3

摘要：

In light of the rapid increase in the number of obesity incidences worldwide, obesity has become an independent risk factor for chronic kidney disease. Obesity-related glomerulopathy (ORG) is characterized by glomerulomegaly in the presence or absence of focal and segmental glomerulosclerosis lesions. IgM and complement 3 (C3) nonspecifically deposit in lesions without immune-complex-type deposits during ORG immunofluorescence. ORG-associated glomerulomegaly and focal and segmental glomerulosclerosis can superimpose on other renal pathologies. The mechanisms under ORG are complex, especially hemodynamic changes, inflammation, oxidative stress, apoptosis, and reduced functioning nephrons. These mechanisms synergize with obesity to induce end-stage renal disease. A slow increase of subnephrotic proteinuria (<3.5 g/d) is the most common clinical manifestation of ORG. Several treatment methods for ORG have been developed. Of these methods, renin–angiotensin–aldosterone system blockade and weight loss are proven effective. Targeting mitochondria may offer a novel strategy for ORG therapy. Nevertheless, more research is needed to further understand ORG.

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Hypertension in patients with CKD in China: clinical characteristics and management

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《医学前沿（英文）》 2017年第11卷第3期页码 307-309 doi: 10.1007/s11684-017-0578-8

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Clinical characteristics and outcomes of biopsy-proven diabetic nephropathy

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《医学前沿（英文）》 2017年第11卷第3期页码 386-392 doi: 10.1007/s11684-017-0574-z

摘要：

Kidney damage is common in patients with diabetes mellitus (DM). However, whether the type of kidney damage can be reliably diagnosed using clinical data alone remains unclear. Predictive factors for diabetic nephropathy (DN) outcomes are also poorly understood. In this study, the clinical manifestations of 111 cases of biopsy-proven DN were described, and the clinical and pathological parameters of patients with different DN outcomes were compared. Results showed that long DM duration (>10 years in 32.4% of patients), severe proteinuria (62.2%), and renal dysfunction (estimated glomerular filtration rate [eGFR]<60 mL/(min·1.73 m²)) (52.3%) did not accurately indicate whether the condition of these patients progressed to DN. Hematuria (48.6%) failed to specify either DN or nondiabetic renal disease. Diabetic retinopathy (78.4%) was a crucial complication in patients with DN. Kaplan–Meier analysis revealed that the renal survival of 53 patients who were diagnosed with DN and were followed up was not significantly associated with glomerular classification (P>0.05). Cox’s regression analysis demonstrated that renal survival time was significantly influenced by sex (b= 1.394, P= 0.038), hematuria (b= 0.036, P= 0.029), and eGFR (b= −0.039, P= 0.002) but was not significantly affected by age, 24 h urinary protein excretion, or glomerular classification (P>0.05). In conclusion, the clinical characteristics of DN vary, and renal biopsy is necessary to determine renal damage patterns. Sex, hematuria, and the eGFR may affect DN outcomes, whereas the glomerular classification may not.

关键词： diabetic nephropathy clinical characteristics renal biopsy outcomes

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Coronavirus disease 2019 (COVID-19): a clinical update

Min Zhou, Xinxin Zhang, Jieming Qu

《医学前沿（英文）》 2020年第14卷第2期页码 126-135 doi: 10.1007/s11684-020-0767-8

摘要： Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has posed a significant threat to global health. It caused a total of 80 868 confirmed cases and 3101 deaths in Chinese mainland until March 8, 2020. This novel virus spread mainly through respiratory droplets and close contact. As disease progressed, a series of complications tend to develop, especially in critically ill patients. Pathological findings showed representative features of acute respiratory distress syndrome and involvement of multiple organs. Apart from supportive care, no specific treatment has been established for COVID-19. The efficacy of some promising antivirals, convalescent plasma transfusion, and tocilizumab needs to be investigated by ongoing clinical trials.

关键词： coronavirus disease 2019 epidemiology pathology radiology clinical characteristics treatment

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Clinical characteristics of 19 neonates born to mothers with COVID-19

Wei Liu, Jing Wang, Wenbin Li, Zhaoxian Zhou, Siying Liu, Zhihui Rong

《医学前沿（英文）》 2020年第14卷第2期页码 193-198 doi: 10.1007/s11684-020-0772-y

摘要： The aim of this study was to investigate the clinical characteristics of neonates born to SARS-CoV-2 infected mothers and increase the current knowledge on the perinatal consequences of COVID-19. Nineteen neonates were admitted to Tongji Hospital from January 31 to February 29, 2020. Their mothers were clinically diagnosed or laboratory-confirmed with COVID-19. We prospectively collected and analyzed data of mothers and infants. There are 19 neonates included in the research. Among them, 10 mothers were confirmed COVID-19 by positive SARS-CoV-2 RT-PCR in throat swab, and 9 mothers were clinically diagnosed with COVID-19. Delivery occurred in an isolation room and neonates were immediately separated from the mothers and isolated for at least 14 days. No fetal distress was found. Gestational age of the neonates was 38.6±1.5 weeks, and average birth weight was 3293±425 g. SARS-CoV-2 RT-PCR in throat swab, urine, and feces of all neonates were negative. SARS-CoV-2 RT-PCR in breast milk and amniotic fluid was negative too. None of the neonates developed clinical, radiologic, hematologic, or biochemical evidence of COVID-19. No vertical transmission of SARS-CoV-2 and no perinatal complications in the third trimester were found in our study. The delivery should occur in isolation and neonates should be separated from the infected mothers and care givers.

关键词： coronavirus disease 2019 severe acute respiratory syndrome-associated coronavirus maternal-infant infection newborn

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Clinical manifestations and pathogen characteristics in children admitted for suspected COVID-19

Xiaofang Cai, Hanlan Jiang, Simin Zhang, Shengying Xia, Wenhui Du, Yaoling Ma, Tao Yu, Wenbin Li

《医学前沿（英文）》 2020年第14卷第6期页码 776-785 doi: 10.1007/s11684-020-0820-7

摘要： Coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has spread around the world. However, approaches to distinguish COVID-19 from pneumonia caused by other pathogens have not yet been reported. We retrospectively analyzed the clinical data of 97 children with probable COVID-19. A total of 13 (13.4%) patients were confirmed positive for SARS-CoV-2 infection by nucleic acid RT-PCR testing, and 41 (42.3%) patients were found to be infected with other pathogens. Notably, no pathogen was detected in 43 (44.3%) patients. Among all patients, 25 (25.8%) had familial cluster exposure history, and 52 (53.6%) had one or more coexisting conditions. Fifteen (15.5%) patients were admitted or transferred to the PICU. In the 11 confirmed COVID-19 cases, 5 (45.5%) and 7 (63.6%) were positive for IgM and IgG against SARS-CoV-2, respectively. In 22 patients with suspected COVID-19, 1 (4.5%) was positive for IgG but negative for IgM. The most frequently detected pathogen was (29, 29.9%). One patient with confirmed COVID 19 died. Our results strongly indicated that the detection of asymptomatic COVID 19 or coexisting conditions must be strengthened in pediatric patients. These cases may be difficult to diagnose as COVID-19 unless etiologic analysis is conducted. A serologic test can be a useful adjunctive diagnostic tool in cases where SARS-CoV-2 infection is highly suspected but the nucleic acid test is negative.

关键词： coronavirus disease 2019 pediatrics emergency retrospective investigation severe acute respiratory syndrome coronavirus 2

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Clinical characteristics of pulmonary hypertension in bronchiectasis

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《医学前沿（英文）》 2016年第10卷第3期页码 336-344 doi: 10.1007/s11684-016-0461-z

摘要：

Pulmonary hypertension (PH), as a complication of bronchiectasis, is associated with increased mortality. However, hemodynamic characteristics and the efficacy of pulmonary arterial hypertension (PAH) therapies in patients with bronchiectasis and PH remain unknown. Patients with bilateral bronchiectasis and concurrent PH were included in the study. Patient characteristics at baseline and during follow-up, as well as survival, were analyzed. This observational study was conducted in 36 patients with a mean age of 51.5 years (range, 17?74 years). The 6 min walking distance was 300.8±93.3 m. The mean pulmonary arterial pressure (PAP) was 41.5±11.7 mmHg, cardiac output was 5.2±1.4 L/min, and pulmonary vascular resistance was 561.5±281.5 dyn·s·cm⁻⁵. The mean PAP was>35 mmHg in 75% of the cases. Mean PAP was inversely correlated with arterial oxygen saturation values (r = −0.45, P = 0.02). In 24 patients who received oral PAH therapy, systolic PAP was reduced from 82.4±27.0 mmHg to 65.5±20.9 mmHg (P = 0.025) on echocardiography after a median of 6 months of follow-up. The overall probability of survival was 97.1% at 1 year, 83.4% at 3 years, and 64.5% at 5 years. Given the results, we conclude that PH with severe hemodynamic impairment can occur in patients with bilateral bronchiectasis, and PAH therapy might improve hemodynamics in such patients. Prospective clinical trials focusing on this patient population are warranted.

关键词： bronchiectasis hemodynamics pulmonary hypertension

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Clinical characteristics and prognostic values of 1p32.3 deletion detected through fluorescence

Huanping Wang, Haitao Meng, Jinghan Wang, Yinjun Lou, Yile Zhou, Peipei Lin, Fenglin Li, Lin Liu, Huan Xu, Min Yang, Jie Jin

《医学前沿（英文）》 2020年第14卷第3期页码 327-334 doi: 10.1007/s11684-019-0712-x

摘要： This study aimed to investigate the prevalence, clinical characteristics, and prognostic impact of 1p32.3 deletion in patients with newly diagnosed multiple myeloma (MM). A retrospective analysis was conducted on 411 patients with newly diagnosed MM; among which, 270 received bortezomib-based therapies, and 141 received thalidomide-based therapies. Fluorescence hybridization (FISH) was performed to detect six cytogenetic abnormalities, namely, del(1p32.3), gain(1q21), del(17p13), del(13q14), t(4;14), and t(11;14). Results showed that 8.3% of patients with MM were detected with del(1p32.3) and had significantly more bone marrow plasma cells ( = 0.025), higher 2-microglobulin levels ( = 0.036), and higher lactate dehydrogenase levels ( = 0.042) than those without del(1p32.3). Univariate analysis showed that patients with del(1p32.3) under thalidomide-based therapies (median PFS 11.6 vs. 31.2 months, = 0.002; median OS 16.8 vs. 45.9 months, <0.001) were strongly associated with short progression-free survival (PFS) ( = 0.002) and overall survival (OS) ( <0.001). Multivariate analysis revealed that del(1p32.3) remained a powerful independent factor with worse PFS ( = 0.006) and OS ( = 0.016) for patients under thalidomide-based treatments. Patients with del(1p32.3) under bortezomib-based treatments tended to have short PFS and OS. In conclusion, del(1p32.3) is associated with short PFS and OS in patients with MM who received thalidomide- or bortezomib-based treatments.

关键词： 1p32.3 deletion 1q21 gain prognosis multiple myeloma FISH bortezomib thalidomide

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Clinical characteristics and risk factors of COVID-19 patients with chronic hepatitis B: a multi-center

《医学前沿（英文）》 2022年第16卷第1期页码 111-125 doi: 10.1007/s11684-021-0854-5

摘要： The coronavirus disease 2019 (COVID-19) has spread globally. Although mixed liver impairment has been reported in COVID-19 patients, the association of liver injury caused by specific subtype especially chronic hepatitis B (CHB) with COVID-19 has not been elucidated. In this multi-center, retrospective, and observational cohort study, 109 CHB and 327 non-CHB patients with COVID-19 were propensity score matched at an approximate ratio of 3:1 on the basis of age, sex, and comorbidities. Demographic characteristics, laboratory examinations, disease severity, and clinical outcomes were compared. Furthermore, univariable and multivariable logistic and Cox regression models were used to explore the risk factors for disease severity and mortality, respectively. A higher proportion of CHB patients (30 of 109 (27.52%)) developed into severe status than non-CHB patients (17 of 327 (5.20%)). In addition to previously reported liver impairment markers, such as alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, and total bilirubin, we identified several novel risk factors including elevated lactate dehydrogenase (≥245 U/L, hazard ratio (HR) = 8.639, 95% confidence interval (CI) = 2.528–29.523; P <0.001) and coagulation-related biomarker D-dimer (≥0.5 μg/mL, HR= 4.321, 95% CI= 1.443–12.939; P = 0.009) and decreased albumin (<35 g/L, HR= 0.131, 95% CI= 0.048–0.361; P <0.001) and albumin/globulin ratio (<1.5, HR= 0.123, 95% CI= 0.017–0.918; P = 0.041). In conclusion, COVID-19 patients with CHB were more likely to develop into severe illness and die. The risk factors that we identified may be helpful for early clinical surveillance of critical progression.

关键词： COVID-19 chronic hepatitis B liver injury coagulation dysfunction

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Clinical features and the traditional Chinese medicine therapeutic characteristics of 293 COVID-19 inpatient

Zixin Shu, Yana Zhou, Kai Chang, Jifen Liu, Xiaojun Min, Qing Zhang, Jing Sun, Yajuan Xiong, Qunsheng Zou, Qiguang Zheng, Jinghui Ji, Josiah Poon, Baoyan Liu, Xuezhong Zhou, Xiaodong Li

《医学前沿（英文）》 2020年第14卷第6期页码 760-775 doi: 10.1007/s11684-020-0803-8

摘要： Coronavirus disease 2019 (COVID-19) is now pandemic worldwide and has heavily overloaded hospitals in Wuhan City, China during the time between late January and February. We reported the clinical features and therapeutic characteristics of moderate COVID-19 cases in Wuhan that were treated via the integration of traditional Chinese medicine (TCM) and Western medicine. We collected electronic medical record (EMR) data, which included the full clinical profiles of patients, from a designated TCM hospital in Wuhan. The structured data of symptoms and drugs from admission notes were obtained through an information extraction process. Other key clinical entities were also confirmed and normalized to obtain information on the diagnosis, clinical treatments, laboratory tests, and outcomes of the patients. A total of 293 COVID-19 inpatient cases, including 207 moderate and 86 (29.3%) severe cases, were included in our research. Among these cases, 238 were discharged, 31 were transferred, and 24 (all severe cases) died in the hospital. Our COVID-19 cases involved elderly patients with advanced ages (57 years on average) and high comorbidity rates (61%). Our results reconfirmed several well-recognized risk factors, such as age, gender (male), and comorbidities, as well as provided novel laboratory indications (e.g., cholesterol) and TCM-specific phenotype markers (e.g., dull tongue) that were relevant to COVID-19 infections and prognosis. In addition to antiviral/antibiotics and standard supportive therapies, TCM herbal prescriptions incorporating 290 distinct herbs were used in 273 (93%) cases. The cases that received TCM treatment had lower death rates than those that did not receive TCM treatment (17/273= 6.2% vs. 7/20= 35%, = 0.0004 for all cases; 17/77= 22% vs. 7/9= 77.7%, = 0.002 for severe cases). The TCM herbal prescriptions used for the treatment of COVID-19 infections mainly consisted of Pericarpium Citri Reticulatae, Radix Scutellariae, Rhizoma Pinellia, and their combinations, which reflected the practical TCM principles (e.g., clearing heat and dampening phlegm). Lastly, 59% of the patients received treatment, including antiviral, antibiotics, and Chinese patent medicine, before admission. This situation might have some effects on symptoms, such as fever and dry cough. By using EMR data, we described the clinical features and therapeutic characteristics of 293 COVID-19 cases treated via the integration of TCM herbal prescriptions and Western medicine. Clinical manifestations and treatments before admission and in the hospital were investigated. Our results preliminarily showed the potential effectiveness of TCM herbal prescriptions and their regularities in COVID-19 treatment.

关键词： COVID-19 traditional Chinese medicine clinical features

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Clinical characteristics in lymphangioleiomyomatosis-related pulmonary hypertension: an observation on

Xiuxiu Wu, Wenshuai Xu, Jun Wang, Xinlun Tian, Zhuang Tian, Kaifeng Xu

《医学前沿（英文）》 2019年第13卷第2期页码 259-266 doi: 10.1007/s11684-018-0634-z

摘要： Lymphangioleiomyomatosis (LAM) is a rare diffuse cystic lung disease. Knowledge on LAM-related pulmonary hypertension (PH) is limited. This study aimed to analyze the clinical characteristics of LAM with elevated pulmonary artery pressure (PAP) and evaluate the potential efficacy of sirolimus. The study involved 50 LAM patients who underwent echocardiography. According to the tricuspid regurgitation velocity (TRV), these patients were divided into the TRV≤2.8 m/s group and TRV>2.8 m/s group. Both groups comprised 25 females with an average age of 38.6±8.1 and 41.5±8.9 years. In the TRV>2.8 m/s group, the estimated systolic PAP (SPAP) was significantly elevated (52.08±12.45 mmHg vs. 30.24±5.25mmHg, <0.01). Linear analysis showed that SPAP was correlated with forced expiratory volume in 1 s (FEV ), diffusing capacity of the lungs for carbon monoxide, alveolar arterial oxygen gradient (P O ), and 6 min walking distance ( = −0.392, −0.351, 0.450, and −0.591, respectively; <0.05), in which P O was a risk factor for SPAP elevation ( = 0.064, OR= 1.066, <0.05). Moreover, in 10 patients who received sirolimus therapy, SPAP decreased from 57.0±12.6 mmHg to 35.2±11.1 mmHg. The study showed that LAM patients with PH exhibit poor pulmonary function and hypoxemia and may benefit from sirolimus treatment.

关键词： lymphangioleiomyomatosis pulmonary hypertension pulmonary function hypoxemia sirolimus

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Clinical characteristics and risk factors for mortality in cancer patients with COVID-19

Junnan Liang, Guannan Jin, Tongtong Liu, Jingyuan Wen, Ganxun Li, Lin Chen, Wei Wang, Yuwei Wang, Wei Liao, Jia Song, Zeyang Ding, Xiao-ping Chen, Bixiang Zhang

《医学前沿（英文）》 2021年第15卷第2期页码 264-274 doi: 10.1007/s11684-021-0845-6

摘要： Patients with cancer are at increased risk of severe infections. From a cohort including 3060 patients with confirmed COVID-19, 109 (3.4%) cancer patients were included in this study. Among them, 23 (21.1%) patients died in the hospital. Cancer patients, especially those with hematological malignancies (41.6%), urinary carcinoma (35.7%), malignancies of the digestive system (33.3%), gynecological malignancies (20%), and lung cancer (14.3%), had a much higher mortality than patients without cancer. A total of 19 (17.4%) cancer patients were infected in the hospital. The clinical characteristics of deceased cancer patients were compared with those of recovered cancer patients. Multivariate Cox regression analysis indicated that a Nutritional Risk Screening (NRS2002) score≥3 (adjusted hazard ratio (HR) 11.00; 95% confidence interval (CI) 4.60–26.32; <0.001), high-risk type (adjusted HR 18.81; 95% CI 4.21–83.93; <0.001), tumor stage IV (adjusted HR 4.26; 95% CI 2.34–7.75; <0.001), and recent adjuvant therapy (<1 month) (adjusted HR 3.16; 95% CI 1.75–5.70; <0.01) were independent risk factors for in-hospital death after adjusting for age, comorbidities, D-dimer, and lymphocyte count. In conclusion, cancer patients showed a higher risk of COVID-19 infection with a poorer prognosis than patients without cancer. Cancer patients with high-risk tumor, NRS2002 score≥3, advanced tumor stage, and recent adjuvant therapy (<1 month) may have high risk of mortality.

关键词： cancer COVID-19 SARS-CoV-2 risk factor mortality

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Clinical characteristics and prognostic factors of patients with mature T-cell lymphoid malignancies:

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《医学前沿（英文）》 2015年第9卷第4期页码 468-477 doi: 10.1007/s11684-015-0419-6

摘要：

Mature T-cell lymphoid malignancies comprise a group of heterogeneous diseases that vary in clinicopathological features, biological behavior, treatment response, and prognosis. Bone marrow (BM) infiltration is more commonly present in mature T-cell lymphoid malignancies compared with their B-cell counterparts and hence important for differential diagnosis. In this study, clinical characteristics and prognostic factors were analyzed in 225 patients with mature T-cell lymphoid malignancies treated in a single institution. These included 29 cases of T-cell lymphoproliferative disorders (T-LPD, all with BM infiltration) and 196 cases of T-/natural-killer-cell lymphoma (T/NKCL, 56 with BM infiltration and 140 without BM infiltration). The estimated 5-year overall survival (OS) rates of T-LPD and T/NKCL were 96.6% and 37.3%, respectively. T-LPD patients were less likely to exhibit poor performance status, advanced disease stage, presence of B symptoms, or abnormal level of serum β-2 microglobulin. With similar pathological characteristics, T/NKCL patients with BM infiltration showed significantly lower response rates and shorter OS than those without BM infiltration (P = 0.0264 and P<0.0001, respectively). Multivariate analysis indicated that poor performance status, advanced disease stage, elevated serum lactate dehydrogenase level, and BM involvement were independent unfavorable prognostic factors. The Glasgow Prognostic Score may be more efficient than the International Prognostic Index in predicting disease outcome in T/NKCL. In conclusion, clinical characteristics may be useful in more effectively stratifying patients with mature T-cell lymphoid malignancies.

关键词： mature T-cell lymphoid malignancies clonal T-cell population bone marrow infiltration prognostic factors

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感染新型冠状病毒的2型糖尿病患者的临床特征和结果——一项回顾性研究 Article

陈滢宇, 陈剑坤, 宫晓, 荣向路, 叶得伟, 金英花, 张忠德, 李际强, 郭姣

《工程（英文）》 2020年第6卷第10期页码 1170-1177 doi: 10.1016/j.eng.2020.05.017

摘要：

据报道，糖尿病及其相关的代谢性疾病是新型冠状病毒肺炎（coronavirus disease 2019, COVID-19）患者的主要合并症。这项临床研究旨在调查有或没有合并糖尿病的COVID-19患者的临床特征、影像学和实验室检查、并发症、治疗方法以及临床结局。这项回顾性研究纳入2020年1月12日至3月25日208例经实验室确认的COVID-19的住院患者（≥45岁）。分析病历信息包括临床特征、影像学和实验室检查、并发症、治疗和临床结果。其中，96名（46.2％）患者患有2型糖尿病。在COVID-19合并2型糖尿病患者中，高血压（58.3％ vs. 31.2％）、冠心病（17.1％ vs. 8.0％）和慢性肾脏病（6.2％ vs. 0％）的共存率明显高于没有2型糖尿病的COVID-19患者。COVID-19合并2型糖尿病患者的CT胸部扫描异常频率和程度显著增加，包括毛玻璃样混浊（85.6％ vs. 64.9％, P < 0.001）和双侧斑片状阴影（76.7％ vs. 37.8％, P < 0.001）。此外，患有糖尿病的COVID-19患者的血糖水平[7.23 mmol·L^‒1 (IQR: 5.80~9.29) vs. 5.46 mmol·L^‒1 (IQR: 5.00~6.46)]、血液中低密度脂蛋白胆固醇（low-density lipoprotein cholesterol, LDL-C）[2.21 mmol·L^‒1 (IQR: 1.67~2.76) vs. 1.75 mmol·L^‒1 (IQR: 1.27~2.01)]和收缩压[130 mmHg (IQR: 120~142) vs. 122 mmHg (IQR: 110~137), P < 0.001]显著高于没有糖尿病的患者（P < 0.001）。2型糖尿病和其他代谢性疾病共存于COVID-19患者中，这可能会增加发病率并加重COVID-19的病情。血糖和脂质代谢的最佳管理是确保更好的临床结果的关键。对于患有糖尿病及其他基础和慢性代谢性疾病的COVID-19患者，应提高临床警惕性。

关键词：新冠病毒肺炎冠状病毒糖尿病临床特征合并症

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人流不全的临床特点分析及生育情况调查

罗岚蓉,李坚

《中国工程科学》 2015年第17卷第6期页码 70-76

摘要：

目的：分析人流不全的临床特点，探讨其发生的高危因素，同时调查患者术后的生育及避孕情况。方法：对首都医科大学附属北京妇产医院2007年10月—2012年10月收治的55例人流不全病历进行回顾性病例分析以及电话随访了解其生育情况及避孕情况。结果：人流不全的主要临床表现为人流术后的异常阴道出血42例（42/55，76.4 %）以及月经异常13例（13/55，23.6 %），超声检查可以发现人流不全造成的宫腔内异常，但需要结合人绒毛膜促性腺激素（HCG）水平的测定以及术后的病理来诊断人流不全。B超下的清宫手术能有效地清除残留的妊娠组织，术后均未再发现宫腔残留。人流不全的高危因素中主要的客观因素为子宫过度屈曲，占23.6 %（13/55），主要的主观因素为宫颈扩张不够，占25.5 %（14/55）。二次清宫术后主要并发症为宫腔粘连，发生率为5.5 %（3/55）。55例患者术后共随访到29例患者，有17例再次妊娠，其中11例妊娠分娩，6例选择人工流产终止妊娠，未发现人流不全二次清宫对生育的明显不良影响。无生育要求的妇女均有意识采取避孕方法来避免意外妊娠。结论：人流不全的主要临床表现为手术后异常的阴道出血，通过结合尿或血的HCG检查以及B超检查，可以及时地发现人流不全。超声指导下清宫是治疗的有效办法。人流不全发生的高危因素，主要客观因素为子宫过度屈曲，主要主观因素为宫颈扩张不够。对于存在高危因素的手术采取超声指示下手术，能够有效地降低人流不全的发生率。人流不全二次清宫术后主要手术并发症为宫腔粘连，无手术并发症发生的患者，未发现明显生育能力的受损。但是对于避孕方法的选择，还需要更多的计划生育服务来帮助她们采取高效的避孕方法。

关键词：人流不全并发症宫腔粘连生育避孕

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