参芪地黄汤联合缬沙坦治疗气阴两虚型早期糖尿病肾病的临床疗效

目的探讨参芪地黄汤联合缬沙坦治疗气阴两虚型早期糖尿病肾病的临床疗效。方法选取2013-01~2014-12该院收治的70例气阴两虚型早期糖尿病肾病患者为研究对象,根据治疗方法的不同分为对照组30例和观察组40例。两组患者均给予糖尿病常规治疗,对照组增加缬沙坦80 mg/次,1次/d。观察组给予参芪地黄汤联合缬沙坦治疗。均连续用药8周。比较两组疗效、治疗前后中医证候积分及不良反应。结果观察组显效23例,有效15例,无效2例。对照组显效13例,有效9例,无效8例。观察组疗效优于对照组(P0.05)。观察组治疗后中医证候积分低于对照组(P0.01)。观察组并发症发生率为0.00%,低于对照组的3.33%,但差异无统计学意义(P0.05)。结论采用参芪地黄汤联合缬沙坦治疗气阴两虚型早期糖尿病肾病临床效果显著,可改善中医证候,且不良反应发生率较低,安全可靠。     

参芪地黄汤对气阴两虚型早期糖尿病肾脏病患者血清炎症因子、肾功能及微循环的影响研究

目的对于气阴两虚型早期糖尿病肾病患者开展参芪地黄汤进行治疗的具体方法以及对患者血清炎症因子、肾功能和微循环所产生的影响施行分析。方法选取该院2018年1月—2019年1月所收诊的气阴两虚型早期糖尿病肾病患者资料100例施行分析,所选100例气阴两虚型早期糖尿病肾病患者通过奇偶法加以分组,其中50例气阴两虚型早期糖尿病肾病患者接受二甲双胍和卡托普利口服治疗作为对照组,剩余50例气阴两虚型早期糖尿病肾病患者接受参芪地黄汤进行治疗作为研究组,对比两组气阴两虚型早期糖尿病肾病患者的治疗效果。结果两组气阴两虚型早期糖尿病肾病患者接受不同治疗措施之后的临床有效率对比差异有统计学意义(P0.05);两组气阴两虚型早期糖尿病肾病患者接受不同治疗措施之后的血清炎症因子水平对比差异有统计学意义(P0.05);两组肾功能对比差异有统计学意义(P0.05);两组微循环水平对比差异明显。结论临床中针对气阴两虚型早期糖尿病肾病患者,为其提供参芪地黄汤治疗效果理想,能够显著缓解患者的蛋白尿,对患者肾功能加以保护,保证微循环获得正常恢复,应该给予大力的推广与应用。     

气阴两虚兼血瘀型2型糖尿病患者血脂水平及中医治疗研究

[目的]探讨气阴两虚兼血瘀型2型糖尿病患者的血脂水平及益气养阴活血方的功效.[方法]41例气阴两虚兼血瘀型2型糖尿病患者为中药治疗组,41例体检正常者为对照组,检测治疗组治疗前后空腹血糖、血脂水平和对照组的血糖、血脂水平.[结果]治疗组用药前与对照组比较,总胆固醇(TC)、三酰甘油(TG)及载脂蛋白B(APO-B)增高(P＜0.01),而APO-A1和高密度脂蛋白胆固醇(HDL-C)降低(P＜0.05);治疗组治疗后TC、TG、APO-B均有显著降低(P＜0.05).[结论]益气养阴活血方能明显改善气阴两虚兼血瘀型2型糖尿病患者的糖代谢和脂代谢.     

苄胺唑啉丹参及大黄预防重症肝炎肝肾综合症

早期应用苄胺唑啉、丹参及大黄治疗急重肝4例,亚重肝14例,慢活肝重型18例.通过对比研究及患者24小时尿量、血尿素氮、血尿肌酐、钠和水负荷试验的观察,发现肝肾综合征发生率:治疗组36.1%(13/36),对照组62%(18/29),(P<0.05);病死率:治疗组38.9%(14/36),对照组65.5%(19/29),(P<0.05),即两组疗效具有显著性差异.该结果提示三种药物早期联合应用,能明显阻止肝肾综合征的发生和发展,能降低病死率.     

慢性病毒性肝炎279例病理诊断与中医证型的关系

目的:探讨慢性病毒性肝炎病理组织学诊断与中医辨证分型之间的关系,为中医辨证提供客观依据。方法:279例均为住院患者,男227例,女52例。全部病例经肝活检证实,其中轻度142例,中度91例,重度46例。慢性乙型肝炎274例,慢性丙型肝炎5例。中医辨证:湿热中阻53例,肝郁脾虚64例,肝肾阴虚29例,脾肾阳虚7例,血瘀血热101例,气阴两虚25例。临床治疗以辨证施治为主。结果:(1)279例慢性肝炎在病理诊断分型中,轻度占50.9%、中度占32.6％、重度占16.4％。(2)在轻度慢性肝炎中,湿热中阻、肝郁脾虚及肝肾阴虚证明显高于血瘀血热证.P=0.01、P<0.05。(3)湿热中阻、肝郁脾虚证的病理诊断分布情况依次为轻度>中度>重度,P<0.01、P<0.05;血瘀血热证轻度与中度分别>重度,P<0.05。但该证在重度中的发生率高于其他证型。(4)脾肾阳虚与气阴两虚证在各病理分型中的分布均无显著差异,P>0.05。结论:(1)慢性肝炎患者以轻度居多,占半数以上。(2)慢性肝病的病变早期以湿热中阻、肝郁脾虚为主证特点,病变部位多在气分;随着肝脏病理损害加重,病变部位及主导证型渐由气分至血分,以血瘀血热为主证特点。(3)治疗上主张早期宜注重清解湿热,疏肝健脾;中、晚期宜重视活血化瘀,凉血解毒。     

2型糖尿病患者证候与β细胞功能的关系

2型糖尿病患者110例按中医辩证分型分为气阴两虚证64例(气阴两虚组)、湿热困脾证46例(湿热困脾组).采用稳态模型的B细胞功能指数(HOMA-β)评价B细胞基础分泌功能,采用早期胰岛素分泌指数(△130/△G30)评价糖负荷后的胰岛素早期分泌功能;采用稳态模型的胰岛素抵抗指数(HOMA-IR)评价胰岛素抵抗(IR).结果湿热困脾组餐后2 h血糖低于气阴两虚组,空腹胰岛素高于气阴两虚组(P均＜0.05).HOMA-β和△I30/△G30的比较,湿热困脾组高于气阴两虚组(P均＜0.05).认为气阴两虚证2型糖尿病与β细胞功能障碍的关系更为密切.     

气阴两虚型HBV相关原发性肝癌患者外周血CD4~+、CD8~+ T细胞特征

目的观察中医证型在乙型肝炎病毒相关原发性肝癌患者(hepatitis B virus related primary liver cancer,HBV-PLC)发生和进展过程中的分布情况,比较不同中医证型外周血T淋巴细胞亚群、B细胞的变化.方法收集在首都医科大学附属北京地坛医院住院的67例HBV-PLC患者,55例乙型肝炎肝硬化患者(liver cirrhosis,LC),40例慢性乙型肝炎患者(chronic hepatitis B virus,CHB).收集3组患者一般资料、临床生化指标和中医辨证分型.采用流式方法检测3组患者外周血中CD3~+T淋巴细胞、CD4~+T、CD8~+T、CD3~-CD19~+B细胞的分布情况.结果从CHB、LC到HBV-PLC进展中气阴两虚型比例增加,肝郁脾虚型减少;在肝癌Child、Okuda、BCLC分期中早期以肝郁脾虚型为主,晚期以气阴两虚型为主.HBV-PLC中气阴两虚型患者与肝郁脾虚型比较:总胆红素、直接胆红素、凝血酶原时间、凝血酶原活动度、B细胞百分比明显升高(P0.01),A/G、CHE、T淋巴细胞、CD8~+T细胞的计数和百分比、CD4~+T细胞计数均明显减少(P0.05).气阴两虚型的LC和HBV-PLC与CHB患者比较,其T淋巴细胞、CD4~+、CD8~+T细胞存在不同程度的降低(P0.05).结论随着肝癌的发生和进展,患者逐渐由肝郁脾虚型为主转为气阴两虚型为主,气阴两虚型患者肝脏功能更差,细胞免疫减弱,病情较重,预后较差.     

乙型肝炎心电图改变与辨证分型规律的探讨

对400例乙型肝炎患者开展心电图检查与辨证分型的研究。结果:辨证分型以气阴两虚兼湿热型及湿热蕴结型心电图异常发生率较高,分别为80％及45％;气阴两虚兼湿热型分别较湿热蕴结型、气虚血淤型,肝郁脾虚型、肝气郁结型显著增高(P值均<0.01);湿热蕴绪型较肝气郁结型显著增高(P<0.01);湿热蕴结型较气虚血淤型、肝郁脾虚型明显增高(P<0.05)。提示乙型肝炎心电图异常发生率与热症有密切关系。     

中医辨证分型加减治疗糖尿病肾病效果的临床观察

目的观察分析在常规常规治疗基础上应用中医辨证分型加减治疗糖尿病肾病的效果。方法以笔者回顾性调查白城市某二级医院2015年以来治疗80例糖尿病肾病患者为研究对象,在西医常规治疗基础上,中医辨证分为气阴两虚型、肝肾不足型、脾肾两虚型和肾虚瘀血型进行治疗,比较四组患者治疗结束后的效果。结果气阴两虚型患者显效15例,有效3例,无效1例,总有效率为94.74%;肝肾不足型患者中,显效7例,有效10例,无效1例,总有效率为94.44%;脾肾两虚型患者中,显效10例,有效15例,无效1例,总有效率为96.15%;肾虚瘀血型患者中,显效4例,有效7例,无效6例,总有效率为64.70%,四组患者治疗效果之间的差异具有统计学意义(疗效Hc=14.06,总有效率x2=12.54,P均0.01)。气阴两虚型与肝肾不足型、脾肾两虚型、肾虚瘀血型两两疗效之间的具有统计学意义(P0.05),说明气阴两虚型糖尿病肾病的疗效最好;气阴两虚型、肝肾不足型、脾肾两虚型与肾虚瘀血型的差异均有统计学意义(P0.05)。结论在常规常规治疗基础上应用中医辨证分型加减治疗糖尿病肾病患者,可获得较为满意的治疗效果,值得临床推广应用。应早期发现和治疗糖尿病肾病患者,不断提高糖尿病肾病患者的治疗效果。     

参芪地黄汤加减治疗气阴两虚兼血瘀型糖尿病的临床疗效观察分析

目的探究参芪地黄汤加减治疗气阴两虚兼血瘀型糖尿病的临床疗效。方法选择2016年3月—2017年3月收治的2型糖尿病患者96例,分为两组,给予不同的方式进行治疗,将两组的治疗效果进行综合分析。结果治疗总有效率:实验组为91.67%,常规组为75.00%(P0.05);治疗前两组的血糖与血脂水平均差异无统计学意义(P0.05);治疗后实验组的血糖与血脂水平均明显改善(P0.05)。结论对气阴两虚兼血瘀型糖尿病患者给予参芪地黄汤治疗的疗效显著,可达到益气养阴的效果,值得采纳。     

Three layer functional model and energy exchange concept of aging process

Relying on a certain degree of abstraction, we can propose that no particular distinction exists between animate or living matter and inanimate matter. While focusing attention on some specifics, the dividing line between the two can be drawn. The most apparent distinction is in the level of structural and functional organization with the dissimilar streams of ‘energy flow’ between the observed entity and the surrounding environment. In essence, living matter is created from inanimate matter which is organized to contain internal intense energy processes and maintain lower intensity energy exchange processes with the environment. Taking internal and external energy processes into account, we contend in this paper that living matter can be referred to as matter of dissipative structure, with this structure assumed to be a common quality of all living creatures and living matter in general. Interruption of internal energy conversion processes and terminating the controlled energy exchange with the environment leads to degeneration of dissipative structure and reduction of the same to inanimate matter, (gas, liquid and/or solid inanimate substances), and ultimately what can be called ‘death.’ This concept of what we call dissipative nature can be extended from living organisms to social groups of animals, to mankind. An analogy based on the organization of matter provides a basis for a functional model of living entities. The models relies on the parallels among the three central structures of any cell (nucleus, cytoplasm and outer membrane) and the human body (central organs, body fluids along with the connective tissues, and external skin integument). This three-part structural organization may be observed almost universally in nature. It can be observed from the atomic structure to the planetary and intergalactic organizations. This similarity is corroborated by the membrane theory applied to living organisms. According to the energy nature of living matter and the proposed functional model, the decreased integrity of a human body's external envelope membrane is a first cause of the structural degradation and aging of the entire organism. The aging process than progresses externally to internally, as in single cell organisms, suggesting that much of the efforts towards the restoration and maintenance of the mechanisms responsible for structural development should be focused accordingly, on the membrane, i.e., the skin. Numerous reports indicate that all parts of the human body, like: bones, blood with blood vessels, muscles, skin, and so on, have some ability for restoration. Therefore, actual revival of not only aging tissue of the human body's membrane, but the entire human body enclosed within, with all internal organs, might be expected. We assess several aging theories within the context of our model and provide suggestions on how to activate the body's own anti-aging mechanisms and increase longevity. This paper presents some analogies and some distinctions that exist between the living dissipative structure matter and inanimate matter, discusses the aging process and proposes certain aging reversal solutions.     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Unusual responses of nocturnal pineal melatonin synthesis and secretion to swimming: Attempts to define mechanisms

Abstract: The effect of swimming at night on rat pineal melatonin synthesis was compared with that of light exposure at night. Rats were forced to swim at 0030 hr (lights out at 2000 hr) and sacrificed by decapitation 15 and 30 min later, immediately after swimming. Other groups of animals were exposed to white light (650μW/cm²) for 15 and 30 min at same time. Swimming caused a rapid and highly significant drop in the melatonin content in the pineal gland; however, the activity of N-acetyltransferase (NAT), the supposed rate limiting enzyme in the melatonin production, was not changed. Despite the drop in pineal melatonin levels, serum concentrations of the indole remained elevated in the rats that swam. In contrast, melatonin levels in the pineal and serum of light exposed rats fell precipitously, accompanied by a significant suppression of NAT activity. Since we anticipated that the strenuous exercise associated with swimming may induce release of artrial natriuretic peptide (ANP) from the heart, which in turn could cause the release of pineal melatonin, in a second study we injected physiological saline intravenously to stretch the cardiac muscle and release ANP. Three milliliters of normal saline was injected during the day into the jugular vein of anesthetized rats that were pretreated with isoproterenol to stimulate pineal melatonin production. Animals were killed 15 min after the saline injection, and pineal NAT activity and pineal melatonin levels were measured. The saline injections caused no alteration in the elevated levels of either NAT or melatonin. These data suggest that the disparity in pineal NAT activity (which was high) and pineal melatonin (which was low), in animals swum at night, may not be caused by ANP which is released during strenuous exercise such as swimming.     

Melatonin and photoperiodic time measurement: Seasonal breeding in the sheep

Abstract: Well-established circadian physiology supports the view that photoperiodic time measurement utilizes the coincidence between the presence of light and a photosensitive phase of a 'biological clock' to alter reproductive status—the so-called external coincidence model of seasonal breeding. In this review, we examine the mechanism whereby photoperiod interacts with presumed suprachiasmatic nuclei activity to allow endogenous melatonin to normally synchronize reproductive activity to the optimal time of year. The Romney Marsh sheep is particularly explored as an experimental model. It is suggested that the on/off activity of seasonal reproduction may be a robust mechanism able to be predictably manipulated by the judicious use of the light/dark cycle and exogenous melatonin, but firmly based on circadian principles.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.