固本益肠汤四联续贯疗法治疗脾虚泄泻疗效观察

[目的]观察固本益肠汤联合甲硝唑、肠道益生菌及食物日志指导的饮食调整四联续贯疗法治疗脾虚泄泻的疗效。[方法]108例脾虚泄泻患者随机分为3组，四联治疗（A）组36例，给予固本益肠汤100ml／次，3次／d，联合甲硝唑200mg，2次／d，整肠生0．5g，3次／d及食物日志指导的饮食调整四联续贯治疗；对照1（B1）组36例，给予甲硝唑、整肠生；对照2（B2）组36例，仅给予甲硝唑，治疗剂量及方法均同A组；以上药物除甲硝唑服用1周外，其他服用至第4周，整肠生在甲硝唑停药后开始服用。所有病例均经结肠镜检查排除器质性疾病。[结果]A组治愈率（77．8％）明显优于B1、B2组（41．7％、13．9％）（P〈0．01），而B1组显效率（74．3％）较132组（30．6％）为优（P〈0．01）。停药后A组6周与12周复发率（8．3％、11．1％）均较B1、B2组（25．8％、42．9％，36．0％、52．0％）低（P〈0．01），B1、B2组12周复发率明显高于6周（P〈0．05）。[结论]固本益肠汤四联续贯疗法治疗脾虚泄泻，可提高治愈率及显效率，降低复发率，较单纯甲硝唑及甲硝唑与肠道益生菌联合治疗为优，临床观察无明显不良反应，是一种较有效的治疗方法。     

脾虚泄泻患者肠道嗜酸细胞主碱基阳离子蛋白和CD3细胞表达与食物过敏的关系

[目的]观察脾虚泄泻与食物过敏及肠道嗜酸细胞炎性递质：嗜酸细胞主碱基阳离子蛋白（MBP）和CD3细胞表达的关系．探讨脾虚泄泻的免疫学机制。[方法]指导298例脾虚泄泻患者做食物臼志，将症状与食物明显相关者（76例，25．5％）分为饮食调整组与对照组各38例．同时对其中9例患者十二指肠黏膜嗜酸细胞炎性递质；MBP和CD3进行免疫组化检测。[结果]饮食调整组4周症状完全缓解率、明显缓解率（23．7％、65．8％）均优于对照组（2．6％、15．8％）．差异有统计学意义（P〈0．01）。免疫组化检测显示其十二指肠黏膜MBP和CD3阳性细胞较对照组表达增强，差异有统计学意义（P〈0．01）。[结论]部分脾虚泄泻与食物过敏所致肠道免疫机制紊乱关系密切．饮食谰整有利于脾虚泄泻症状的缓解。     

痛泻安肠方治疗肝郁脾虚证腹泻型肠易激综合征的随机对照临床研究

[目的]观察痛泻安肠方治疗肝郁脾虚证IBS-D的临床疗效及安全性。[方法]将64例患者随机分为试验组31例,对照组33例。试验组予痛泻安肠方联合匹维溴铵片,对照组单用匹维溴铵片,筛选期2周,治疗期4周,随访期4周。[结果]①IBS-SSS疗效:治疗4周后试验组总有效率93.3%,对照组76.7%,2组间差异有统计学意义(P=0.008)。②肝郁脾虚证泄泻病常见症状分级量化表积分疗效:试验组有效率93.4%,对照组70.0%,2组间疗效差异有统计学意义(P=0.008)。③单项症状:试验组对腹痛症状改善有效率93.3%,对照组54.3%,2组间差异有统计学意义(P=0.000)。2组间对腹胀与腹泻的改善有效率差异均无统计学意义。[结论]痛泻安肠方治疗肝郁脾虚证IBS-D有效且安全。     

固本调肠汤治疗腹泻型肠易激综合征疗效观察

[目的]观察中药固本调肠汤治疗脾肾阳虚型腹泻型肠易激综合征(IBS-D)的疗效.[方法]将90例患者随机分为2组,各45例,治疗组予固本调肠汤,对照组予马来酸曲美布汀胶囊治疗.治疗4周,采用临床积分差值法,观察IBS-D的总疗效及主要症状疗效.[结果]治疗后,治疗组改善IBS-D主要症状腹痛、大便次数及性状疗效优于对照组(P＜0.05);改善疾病的严重度疗效优于对照组(P＜0.05).[结论]以温肾健脾法为组方原则的固本凋肠汤对IBS-D的临床疗效明显优于马来酸曲美布汀.     

中西医结合治疗肠易激综合征临床观察

[目的]观察中西医结合治疗肠易激综合征(IBS)的临床疗效。[方法]将107例IBS患者随机分为2组,对照组(53例)采用常规心理调节,饮食指导及对症治疗;治疗组(54例)按不同的中医证候分成不同的证型,在西医治疗的基础上加用对应的中药汤剂,2组疗程均为4周。[结果]对照组总有效率为60.4%;治疗组总有效率为92.6%。治疗组优于对照组(P0.05)。[结论]加用中医辨证治疗IBS比单纯用西医常规治疗疗效更好。     

美沙拉嗪联合固本益肠片对溃疡性结肠炎患者炎症因子及肠黏膜屏障功能的影响

[目的]探讨美沙拉嗪联合固本益肠片对溃疡性结肠炎(ulcerative colitis,UC)患者炎症因子及肠黏膜屏障功能的影响。[方法]入选80例UC患者为研究对象,根据患者对治疗方案的选择分为观察组(40例)和对照组(40例);观察组口服美沙拉嗪联合固本益肠片治疗,对照组单服美沙拉嗪治疗。观察2组治疗前后炎症因子、肠黏膜屏障功能、肠道菌群及中医证候积分的变化。[结果]治疗前2组患者炎症因子、肠黏膜屏障功能、肠道菌群及中医证候积分水平比较均差异无统计学意义(P0.05)。疗程结束后与治疗前比较,观察组INF-γ水平无明显变化,对照组INF-γ水平明显升高(P0.05);2组IL-1β、IL-17、IL-23、D-乳酸、UAMY、DAO水平均较治疗前明显降低(P0.05)。与治疗前比较,疗程结束后2组肠球菌、大肠埃希菌明显减少,乳酸杆菌、双歧杆菌明显增加(P0.05),各项中医证候积分明显降低(P0.05);观察组治疗后各项指标变化水平均明显优于对照组(P0.05)。[结论]美沙拉嗪联合固本益肠片比单独使用美沙拉嗪治疗UC效果更好,安全性更高,值得临床推广应用。     

基于“微生物-脑-肠轴”观察理肠汤对脾虚湿困型溃疡性结肠炎患者的作用

[目的]探讨理肠汤通过"微生物-脑-肠轴"对溃疡性结肠炎(UC)患者的作用。[方法 ]治疗组以理肠汤联合柳氮胺吡啶肠溶片,单纯服用柳氮磺胺吡啶肠溶片为对照组,干预脾虚湿困型UC患者,对比2组患者肠道微生态、血清脑肠肽、短链脂肪酸的改善情况。并对比患者结肠镜下黏膜评分的改善程度。[结果]治疗组在双歧杆菌、乳杆菌、酵母菌的改善方面明显优于对照组(P0.05);对SP、SS、乙酸、丙酸的调节优于对照组(P0.05);对患者肠镜下黏膜变脆易损及黏膜损害改善也明显优于对照组(P0.05)。且在治疗过程中未发现临床不良事件的发生。[结论]理肠汤对脾虚湿困型UC患者安全有效。     

平息汤联合益生菌预防结肠息肉术后复发的研究

[目的]观察平息汤联合益生菌预防结肠息肉术后复发的临床疗效。[方法]选取2017年1月～2017年6月在我院内镜中心行结肠息肉电凝电切术的140例患者,将其分为西药组、中药组、中西联合组与对照组,每组各35例。西药组服用双歧杆菌三联活菌肠溶胶囊,中药组予中药平息汤,中西联合组同时予中药平息汤和双歧杆菌三联活菌肠溶胶囊,对照组不予中药和西药干预,只按医嘱合理安排饮食。所有患者分别于术后半年与1年复查结肠镜。[结果]中西联合组结肠息肉半年复发率明显低于对照组、西药组及中药组(P0.05),中药组结肠息肉半年复发率明显低于对照组(P0.05);中西联合组结肠息肉1年复发率明显低于对照组、西药组及中药组(P0.05),中药组结肠息肉1年复发率明显低于对照组及西药组(P0.05)。[结论]平息汤联合益生菌可有效预防结肠息肉术后患者的息肉复发。     

肠益清治疗肠易激综合征脾虚湿盛证的疗效观察

[目的]观察肠益清配方颗粒治疗腹泻型肠易激综合征脾虚湿盛证的临床疗效.[方法]将106例患者随机分为治疗组和对照组,每组各53例.治疗组予以肠益清配方颗粒加减治疗,对照组用匹维溴胺和复方嗜酸乳杆菌口服治疗,4周为1个疗程.采用症状尺度表、大便性状表及生活质量量表记录2组患者的症状变化.[结果]治疗组总有效率为88.7％,对照组为67.9％,治疗组疗效明显优于对照组（P＜0.05）.[结论]肠益清配方颗粒治疗肠易激综合征脾虚湿盛证的临床疗效满意,值得推广.     

中药联合热熨治疗肠易激综合征45例临床观察

[目的]观察中药汤剂联合外治治疗肠易激综合征（IBS）的临床效果.[方法]将136例IBS患者随机分为3组：联合治疗组45例,使用中药汤剂及热熨治疗;中药组45例,单纯使用中药汤剂治疗;西药组46例,予匹维溴安、复方嗜酸乳杆菌治疗.[结果]联合治疗组总有效率93.3％,中药组总有效率84.4％,西药组总有效率76.1％[结论]中药联合外治治疗IBS疗效确切.     

A patient with rectal ulcer with severe stenosis presenting with perforated peritonitis

We report a patient with rectal ulcer with severe stenosis, who underwent urgent surgical treatment for perforated peritonitis. The 54-year-old man suddenly developed cramping abdominal pain and fever while hospitalized, with signs of peritoneal irritation. An emergency laparotomy was performed, and severe stenosis of the rectum and a perforated lesion on the oral side approximately 10 cm distant from the stenosis were found, with massive abdominal purulent fluid. He was treated by rectosigmoid colon resection with transverse colon loop colostomy. Histopathologically, the stenosis was caused by ulceration extending to all muscular layers of the rectum, with inflammatory changes. Benign rectal stenosis is so rare that differential diagnosis from malignancy may be difficult when there are inflammatory changes in the surrounding tissues. However, it is necessary to keep in mind the likelihood of this disease in differentiation from rectal cancer. Received: December 21, 1998 / Accepted: May 28, 1999     

Evaluation of atrial vulnerability with transoesophageal stimulation in patients with atrioventricular junctional: Comparison with patients with ventricular pre-excitation and with normal subjects

The aim of our work was to evaluate the inducibility of atrialfibrillation in a group of patients with atrioventricular junctionalreentrant tachycardia and to compare it with that of patientswith a Kent-type ventricular pre-excitation (Wolff-Parkinson-Whitesyndrome) and a control group. One hundred and twenty-five subjects were separated into groups.Group 1 comprised 49 Wolff-Parkinson-White patients, with amean age of 26.4, range 10.66 years; group 2, 51 patients withatrioventricular junctional reentrant tachycardia inducibleby transoesophageal atrial stimulation andlor clinically documented,with a mean age of 43.4, range 16–78 years; group 3, 25control subjects with a mean age of2.64, range 13–76 years. Each subject underwent atrial transoesophageal stimulation withthe following protocol: programmed atrial stimulation with 1and 2 stimuli during atrial pacing of 100. min^–1 and 150.min^–1; atrial stimulation for 10 s at a rate of 200–300–400–500–600.min^–1 with intervals of 10 s between stimulations, fivesuccessive ‘ramp-up’ atrial stimulations for 9 swith the rate increasing from 100 to 800. min^–1 with intervalsof 10 s between stimulations. The end point was the completionof the protocol or induction of sustained atrial fibrillation(>1 min). The chi-square test was used for statistical analysis. Our resultsshowed that in group 1 atrial fibrillation was induced in 27149patients (55.1%); this was sustained in 13149 (26.5%) and non-sustainedin 14149 (28.5%); in group 2, atrial fibrillation was inducedin 22151 patients (43.0%); it was sustained in 7151 (13.7%)and non-sustained in 15151 (29.4%); in group 3, sustained atrialfibrillation was not induced in any subject and in only onesubject was a non-sustained atrial fibrillation (4 s) induced. The chi-square test showed that group 2 vs group 1 were non-significant,while group 2 vs group 3 and group 1 vs group 3 were significant(P<0.003 and P<0.0007, respectively). Therefore group 2 patients showed a greater atrial vulnerabilityin comparison to the control subjects and a similar vulnerabilityto group 1 patients. It is possible that the greater atrialvulnerability in the patients of group 2 was due to the doublenodal pathway.     

肿瘤病人弓形虫感染分析

在肿瘤的发生和发展进程中 ,多伴有免疫功能低下或缺陷 ,从而极易遭受各种感染。弓形虫是机会感染因子 ,当患者免疫功能受损时 ,易于感染 ,还会使隐性感染激活 ,引起低热不退、淋巴结肿和脑神经系统的反应 ,此现象尚未引起临床医师的重视。近年来 ,我们对 4 0 9例肿瘤病人进行了弓形虫感染及弓形虫病的分析观察 ,报告如下 :1　材料与方法1 1　材料　 30 4例病人血清取自江西省肿瘤医院住院或门诊病人 ,随机抽样后低温保存待检 ,10 5例取自其他医院送检样品 ,有急性症状者随到随检 ,以便及时做病原学检测。1 2　弓形虫病诊断方法1 2 1　免疫…     

Infection with Rhodococcus equi in a patient with sarcoidosis treated with corticosteroids

A 51-year-old female farmer was diagnosed as having sarcoidosis. During 4 years of observation, slow radiological progression was observed. Cough then developed, necessitating treatment with corticosteroids. After 28 months of continuous treatment with prednisolone in low doses (5-7.5 mg daily), she suffered fever episodes, recurrent haemoptyses, general malaise and loss of weight. A chest roentgenogram showed a left upper lobe infiltrate, which progressed and finally cavitated, and rib destruction. Despite efforts, including a thoracotomy, 22 months passed before a diagnosis could be made. Blood and sputum cultures and cultures from the destroyed rib showed growth of Rhodococcus equi, a common soil organism which can cause infections in foals and other animals. Treatment with rifampicin and erythromycin was successful. R. equi has been reported to cause infection in patients with neoplastic disease and/or immunosuppression, but the disease might be more common than is suggested by the sparse case reports in the literature, owing to lack of familiarity with the organism, which will tend to be overlooked as a contaminant.     

Treating patients with lupus with B-cell depletion

A new era in the treatment of systemic lupus erythematosus has dawned with the increasing introduction of monoclonal antibodies and other approaches, that target the key molecules involved in the pathogenesis of the disease. At present the ability to block the CD20 molecule on those B cells that carry this marker has proved the most effective way to treat patients resistant to conventional immunosuppressive drugs. However, these studies have all been open label and the results of double blind controlled studies are eagerly awaited.