高血压病患者中医证候与体重指数的关系研究

目的探讨高血压病（EH）患者中医证候与体重指数（BMI）的关系。方法对333例住院EH患者行中医辨证和身高、体重测定,并计算BMI。333例EH患者按中医辨证分为9组,另外根据虚实辨证及夹痰、夹瘀辨证原则进行辨证分组。结果333例EH患者证候分布如下：阴虚阳亢证26例（7.8％）,气虚痰浊证13例（3．9％）,气虚血瘀证52例（15．6％）,气阴两虚证20例（6．0％）,痰瘀互阻证30例（9．0％）、气阴两虚,痰浊蕴阻证19例（5．7％）、气阴两虚,瘀血阻络证74例（22．2％）,气阴两虚、痰瘀互阻证61例（18．3％）,气虚痰浊、瘀血阻络证38例（11．4％）;根据虚实辨证将333例EH患者分为单纯虚证、单纯实证、虚实夹杂证3组,其中单纯虚证（气阴两虚证）与单纯实证（痰瘀互阻证）高血压患者的BMI水平具有统计学意义（P〈0．05）;根据夹痰、夹瘀不同将333例EH患者分为夹痰证、夹瘀证、夹痰夹瘀证、非夹痰夹瘀证4组,夹痰夹瘀证高血压患者BMI水平较夹瘀证和非夹痰夹瘀证增大P〈0．05或P〈0．01）,夹痰证患者BMI水平较夹瘀证增高P〈0．05）。结论EH患者痰证的存在可能是影响BMI水平增加的主要因素之一,EH合并肥胖的患者需要结合中医辨证采用燥湿化痰、清热化痰、温化寒痰、润燥化痰、治风化痰等方法协助减轻体重、降低血压。     

代谢综合征中医证候与血清脂肪因子表达规律研究

目的通过对代谢综合征(MS)常见中医证型的分析和血清脂肪因子水平的检测,研究MS患者中医证候规律及其与血清脂肪因子的相关性。方法对235例代谢综合征患者进行中医辨证分型,分为痰瘀互结组、痰浊阻遏组、气阴两虚组和阴虚热盛组,检测其血清脂肪因子,并对中医证候进行频数分析。结果痰瘀互结组和痰浊阻遏组血清瘦素(LEP)、肿瘤坏死因子α(TNF-α)、白细胞介素-6(IL-6)、血清抵抗素(Resistin)、纤溶酶原激活物抑制物-1(PAI-1)水平较高,与气阴两虚组比较差异有统计学意义(P<0.05);痰瘀互结组和痰浊阻遏组血清脂联素(APN)水平较低,与气阴两虚组比较差异有统计学意义(P<0.05);气阴两虚组视黄醇结合蛋白-4(RBP4)较高,与其他3组比较差异有统计学意义(P<0.05)。代谢综合征中医症状、舌脉及病机出现的频次和频率具有一定规律,其病机出现的频次和频率由高到低依次为痰浊阻遏>痰瘀互结>气阴两虚>阴虚热盛。结论痰浊和血瘀可能是脂肪因子分泌及代谢异常并导致代谢综合征的关键病理环节。     

代谢综合征胰岛素抵抗与中医证候辨证分型关系研究

目的通过观察代谢综合征胰岛素敏感性指标与中医证候辨证分型之间的相互关系,旨在寻找其存在的内在规律,为中医临床辨证与治疗提供客观化指标。方法对120例代谢综合征的患者进行中医辨证分型,并选择同年龄段的30例健康正常人作对照组,分别测量身高、体质量、血压,检测胰岛素、血糖、三酰甘油、高密度脂蛋白等,分析以上指标与中医辨证分型间的相关性,并观察不同中医证型中胰岛素敏感指数(ISI)的差异性。结果代谢综合征各组患者的体质指数、血压、三酰甘油、高密度脂蛋白胆固醇等方面与正常对照组差异有统计学意义(P<0.05),但组间差异无统计学意义(P>0.05);ISI低于正常对照组(P<0.05),而中医各证型存在不同程度胰岛素抵抗的现象,具体为气阴两虚证<阴虚热盛证<痰瘀互结证<痰浊内蕴证(P<0.05)。结论ISI可反映代谢综合征的严重程度,可将ISI作为代谢综合征的中医辨证的客观指标,具有较好的特异性。     

急性脑梗死中医证型与NIHSS评分关系的研究

目的 探讨急性脑梗死患者中医证型和美国国立卫生研究院卒中量表(NIHSS)评分的关系.方法 收集急性脑梗死病例122例,进行中医辨证,统计每个患者的证型合并数与NIHSS评分,分析证型合并数与NIHSS评分的关系;统计每个证型患者的NIHSS评分,按证型分为6组,比较各组之间NIHSS评分.结果 急性脑梗死患者中医证型合并数与NIHSS评分不相关(P>0.05);瘀证的NIHSS评分与其他证型NIHSS评分比较差异有统计学意义(P<0.05).结论 急性脑梗死患者症状的轻重、预后与中医证型合并数的多少无关;急性脑梗死患者合并瘀证的患者较其他证型患者临床症状重、预后差.     

腹型肥胖高血压中医证候特点及与靶器官损害的相关性分析

目的探索腹型肥胖高血压病人中医证型分布特点,并分析"痰瘀"病理因素与腹型肥胖高血压相关性,为中西医结合有效控制肥胖高血压及防治靶器官损害提供一定的依据。方法采用横断面流行病学调查方法,共纳入上海地区227例腹型肥胖高血压病人,采集一般资料、中医症状、糖脂代谢、早期肾脏损害指标、心脏超声等,结合四诊进行中医辨证,按有无痰瘀兼夹证进行比较,对相关数据进行统计分析。结果腹型肥胖高血压病人中肝火亢盛证76例(33.5%),阴虚阳亢证42例(18.5%),痰湿壅盛证84例(37.0%),阴阳两虚证23例(11.0%),兼有痰瘀互结证共106例(46.7%)。痰瘀互结组较非痰瘀互结组室间隔厚度、左室收缩末内径和左室重量指数(LVMI)显著升高(P0.05),痰瘀互结组较非痰瘀互结组合并症数目、合并冠心病比例(59.4%vs 43.8%)、糖化血红蛋白、胱抑素C、尿微量白蛋白(MA)/肌酐(Cr)和尿MA显著增加(P0.05)。结论上海地区腹型肥胖高血压的中医证型以痰瘀互结证居多;痰瘀互结证易发生左室肥厚,且冠心病患病率和早期肾损害指标更高。     

74例慢性乙型重型肝炎中医证候特点分析

目的 探讨慢性乙型重型肝炎(chronic severe hepatitis B,CSHB)中医证候规律,明确辨证分型与相关实验室指标及并发症之间的相关性.方法 收集2009年7月-2010年3月在首都医科大学附属北京佑安医院住院的CSHB患者辨证分型、相关实验室指标及并发症情况,以国家“十一五”传染病重大专项“慢性重型肝炎证候规律及中西医结合治疗方案研究”制定的辨证分型方案进行辨证,分析中医辨证分型与实验室指标及并发症之间的关系.结果 ①纳入的74例CSHB患者中医辨证分型以气虚瘀黄证(25.7％)、阳虚瘀黄证(16.2％)、湿热发黄证(27.0％)和瘀热发黄证(21.6％)较为常见,阴虚瘀黄证(9.5％)较少见.②5型在TBIL、PT、中性粒细胞百分比(NEUT％)及HGB等指标的差异均无统计学意义,但若将5型合并为虚证和实证统计分析,则虚证组NEUT％高于实证组,2组间差异有统计学意义.③5型在腹水、肝性脑病、自发性细菌性腹膜炎、电解质紊乱及肝肾综合征等并发症的发病率方面差异均无统计学意义,但若将5型合并为虚证和实证进行统计分析,则虚证组腹水发病率高于实证组,2组间差异有统计学意义.结论 按5型进行辨证,相关实验室指标与并发症无明显差异;若分为虚证和实证,实验室指标与并发症发病率有一定差异.CSHB的中医辨证与实验室指标和并发症之间具有一定的相关性,临床应该首重虚实辨证.     

冠心病痰瘀辨证与冠脉病变特点的相关性研究

目的探讨冠心病(coronary heart disease,CHD)痰瘀辨证与冠状动脉病变特点之间的关系,为证候客观化研究提供依据。方法入选经冠状动脉造影术(coronary angiography,CAG)确诊的冠心病患者368例,观察冠脉病变程度(累及支数、狭窄度)与痰瘀辨证之间的关系。结果不同狭窄程度例数在各中医痰瘀辨证的分布:轻度、中度狭窄以非痰瘀证多见;重度狭窄(51/368)、完全狭窄(26/368)以痰瘀相兼证主(P<0.05)。不同狭窄程度支数在各中医证型分布情况:轻度、中度狭窄以非痰瘀证多见(P<0.05);重度狭窄、完全狭窄以痰瘀相兼证(123/755、41/755)为主(P<0.05)。冠脉病变支数与痰瘀辨证关系:冠脉单支病变者以非痰瘀证为主,多支病变者以痰瘀相兼证为主。各中医证型组间冠脉病变总支数由痰浊证、血瘀证、痰瘀相兼证、非痰瘀证逐渐增加。结论冠心病痰瘀辨证与冠脉病变程度之间有一定的关系。     

肝豆状核变性患者骨代谢指标变化与中医证型的相关性研究

目的 探讨肝豆状核变性(WD)患者骨代谢指标变化与中医证型的相关性.方法 对45例WD 患者行骨钙素(BGP)、骨碱性磷酸酶(BAP)、Ⅰ型胶原末端肽(NTX)检测.并和25名健康对照者比较,进行中医证型组间对比分析.结果脾肾阳虚组、肝肾阴虚组、痰瘀互结组BGP水平与对照组比较均有统计学意义(P<0.05或P<0.01),痰湿中阻组与对照组比较无统计学意义(P>0.05);痰瘀互结组、痰湿中阻组与脾肾阳虚组相比较有统计学意义(P<0.05或P<0.01).中医证型各组BAP水平与对照组比较均有统计学意义(P<0.05或P<0.01).痰湿中阻组与脾肾阳虚组有统计学意义(P<0.05).与对照组比较,NTX水平中医证型各组均有统计学意义(P<0.01),组间比较无统计学意义(P>0.05).结论 WD患者不同中医证型间骨代谢指标存在明显差异.WD患者不同中医证型间骨代谢指标的差异可以作为指导WD中医治疗的参考依据.     

180例阻塞性睡眠呼吸暂停低通气综合征患者临床特征分析

目的探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者中医证型及其多导睡眠监测指标的特征。方法经多导睡眠监测确诊为OSAHS患者180例,中医辨证分型标准分为五组:痰瘀互结证、痰热内扰证、痰湿内阻证、脾肾阳虚证、气阴两虚证。比较各组多导睡眠监测低通气指数(AHI)、氧减指数、平均血氧饱和度(SaO2)、最低SaO2的值。结果证型分布由多至少排列依次为痰热内扰证,痰湿内阻证,痰瘀互结证,脾肾阳虚证,气阴两虚证。痰热内扰证的多导睡眠监测AHI、氧减指数和Epuorth量表(ESS)评分均显著高于其他四组,差异有统计学意义。结论痰热内扰证是阻塞性睡眠呼吸暂停低通气综合征的主要证候类型,进一步研究痰热内扰证型OSAHS的中医药治疗,将具有更重要的临床价值。     

中西医结合治疗糖尿病合并急性脑梗死182例疗效分析

目的探讨中西医结合治疗糖尿病合并急性脑梗死的疗效。方法选择糖尿病合并脑梗死患者182例作为研究对象,随机分为治疗组和对照组。对照组91例采用西医治疗,治疗组91例根据中医理论,运用重要辨证治疗。结果糖尿病合并脑血管病组证候演变规律为阴虚风动证→痰火证→痰瘀证→气虚血瘀证。中医方法治疗此病,其疗效远高于单纯进行西医治疗。结论中西医结合治疗糖尿病合并急性脑血管病,明显提高患者的生存质量,降低死亡率。     

Syndromic Disorders with Short Stature

Short stature is one of the major components of many dysmorphic syndromes. Growth failure may be due to a wide variety of mechanisms, either related to the growth hormone (GH)/insulin-like growth factor axis or to underlying unknown pathologies. In this review, the relatively more frequently seen syndromes with short stature (Noonan syndrome, Prader-Willi syndrome, Silver-Russell syndrome and Aarskog-Scott syndrome) were discussed. These disorders are associated with a number of endocrinopathies, as well as with developmental, systemic and behavioral issues. At present, GH therapy is used in most syndromic disorders, although long-term studies evaluating this treatment are insufficient and some controversies exist with regard to GH dose, optimal age to begin therapy and adverse effects. Before starting GH treatment, patients with syndromic disorders should be evaluated extensively.     

Patients’ experiences of a diagnosis of Hughes’ syndrome

The objectives of the study were to describe the experience of patients immediately prior to a diagnosis of Hughes syndrome (HS) or antiphospholipid syndrome and post-diagnosis. A questionnaire survey was carried out set in the Hughes Syndrome Foundation, St. Thomas’ Hospital, London, 2006. Participants were all patients who are members of the Hughes Syndrome Foundation. The main outcome measures were responses to a questionnaire relating to the experiences of people with a diagnosis of HS, such as number of hospitalisations, number of consultants seen, number of miscarriages, etc. A total of 157 patients completed the questionnaire, giving a response rate of 60.4%. Most (85%) were women and mean age was 46 years (SD 12). The median time to diagnosis was 3 years. The median number of consultants seen was 2 (max 19) with a median time in hospital pre-diagnosis of 10 days. The most common initial diagnoses were migraines, multiple sclerosis and systemic lupus erythematosus. Among women, 46% had had a miscarriage. Two thirds of respondents thought a blood test would have led to an earlier diagnosis. Comments from patients indicated a lack of awareness among specialists and general practitioners. The survey demonstrated a long time lag for diagnosis of Hughes syndrome, with increased costs to the NHS and emotional and financial cost to the patient. Greater awareness of this condition would benefit patients and the NHS.     

从痰湿瘀热论治2型糖尿病代谢综合征52例

目的观察从痰、湿、瘀、热立论应用清热祛浊胶囊治疗2型糖尿病代谢综合征的疗效。方法 52例2型糖尿病代谢综合征患者,在原基础治疗基础上,加服清热祛浊胶囊5粒,每日3次。3个月后观察指标变化。结果治疗后患者的空腹血糖、餐后2 h血糖、糖化血红蛋白、三酰甘油、低密度脂蛋白胆固醇、收缩压、舒张压、体重指数明显下降(P<0.05或P<0.01);高密度脂蛋白胆固醇有所升高,但无统计学意义。治疗总有效率82.7%。结论从痰、湿、瘀、热立论组方的清热祛浊胶囊可以改善2型糖尿病代谢综合征患者的高血糖、高血压、高血脂、肥胖等多种心血管危险因子。     

The postcardiac injury syndromes.

Late pericarditis following myocardial infarction, cardiac surgery, or trauma is referred to as postmyocardial infarction syndrome (PMIS) or postcardiotomy syndrome (PCS), respectively. The term postcardiac injury syndrome (PCIS) is used to encompass both these entities. PCIS is characterized by fever, pleuropericardial pain, pericarditis, and pulmonary involvement. Abnormal laboratory findings include leukocytosis, high sedimentation rate, and chest x-ray abnormalities of pleural effusion with or without pulmonary infiltrates. Evidence supports an immunopathic etiology; viruses may play a contributing role. The course is benign but rare complications include tamponade, constriction, anemia, and coronary bypass graft occlusion. Anti-inflammatory agents are helpful; indo-methacin and steroids are preferably avoided. Rarely, PMIS-like syndrome may occur following pulmonary embolism. Anticoagulation and steroids have been used successfully in the latter situation.     

预激综合征合并快慢综合征的临床分析

目的通过对12例预激综合征合并室上性心动过速患者临床及电生理资料的分析,提出室上性心动过速发作结束时伴发的晕厥可能是窦房结功能一过性受抑的结果,探讨和证实这一发生机制设想的合理性.方法12例预激综合征合并室上性心动过速患者,男8例,女4例,平均年龄32.5岁(19～49岁).均因室上性心动过速伴晕厥住院.经各种电生理检查评价窦房结功能,冠脉造影排除冠脉的异常,并进行射频消融术和(或)抗心动过速起搏器治疗.随访2～5年.结果12例患者均符合下列条件预激综合征伴发室上性心动过速结束时有晕厥发生,年龄多属青年、中年,经各种电生理检查提示窦房结功能正常.冠脉造影证实冠状动脉正常,室上性心动过速终止时心电图均证实为较长时间的窦性停搏.4例经植入抗心动过速起搏治疗,3例经射频消融术及抗心动过速起搏器治疗,5例经射频消融术治疗,经2～5年的随访,全组12例患者无一例再发生室上性心动过速及晕厥.结论预激综合征合并室上性心动过速伴发的晕厥均由功能性病态窦房结功能障碍机制引起,尽管因果关系明确,但与多数预激综合征患者的临床经过不一致的原因尚不清楚,有待进一步探讨.此外,这些符合快慢综合征患者晕厥治疗和预防的关键是根治室上性心动过速,植入人工心脏起搏器预防晕厥似乎必要性不大.     

遗传性低钾失盐性肾小管病临床分析

目的：分析遗传性低钾失盐性肾小管病的临床特点。方法：回顾性分析上海瑞金医院肾内科住院治疗Bartter综合征和Gitelman综合征共23例，其中经典型Bartter综合征4例，Gitelman综合征19例。结果：4例Bartter综合征发病年龄4月-33岁，临床上以多饮、多尿、乏力主要表现，2例患儿表现为脱水、呕吐、生长发育障碍；19例Gitelman综合征患者发病年龄10—52岁，临床上以双下肢无力、多饮、多尿、夜尿增加为主要表现，部分Gitelman综合征患者伴手足抽搐；实验室检查均表现为低血钾代谢性碱中毒，尿钾排出增加，血肾素活性、血管紧张素Ⅱ及醛固酮明显升高。而血压正常；经典型Bartter综合征尿钙肌酐比〉0．2，Gitelman综合征表现为低血镁、低尿钙、低尿钙肌酐比〈0．2；补钾或联合消炎痛、安体舒通和门冬氨酸钾镁等药物治疗后症状缓解。结论：低钾失盐性肾小管病主要特点包括低血钾代谢性碱中毒、高尿钾、血肾素、血管紧张素Ⅱ、醛固酮水平增高而血压正常，Bartter综合征和Gitelman综合征鉴别主要在发病年龄、血镁和尿钙水平，本病治疗应补钾、补镁、前列腺素合成酶抑制剂、醛固酮拮抗剂等多种药物联合应用。     

Somatotype and idiopathic mitral valve prolapse

Records from 18 subjects with angiographic idiopathic mitral valve prolapse, 28 subjects with merely exaggerated posterior mitral leaflet systolic bulging, and 100 subjects with normal hemodynamic and angiographic findings were compared with regard to age, sex, height, weight, ponderal index (height/³ weight), auscultatory and echocardiographic abnormalities. Chest x-ray films available for subjects with mitral valve prolapse were reviewed. The ponderal index of subjects with mitral valve prolapse (13.1 ± 0.8) differed from that of subjects with merely exaggerated posterior mitral leaflet systolic bulging (12.6 ± 0.7) (P < 0.02) and from that of subjects without angiographic abnormality (12.3 ± 0.8) (P < 0.001). The three groups differed in ponderal index when equated statistically for age, height, weight, and sex (P < 0.001). Among mitral valve prolapse patients, an asthenic habitus occurred independent of the presence of thoracic skeletal abnormalities.     

Relapsing catastrophic antiphospholipid syndrome: report of three cases

BACKGROUND: The catastrophic variant of the antiphospholipid syndrome (CAPS), also now known as Asherson's syndrome, is defined as a potential life-threatening variant of the antiphospholipid syndrome, which is characterized by multiple small-vessel thrombosis that can lead to multiorgan failure. Relapses in patients with the CAPS are very uncommon. OBJECTIVE: To describe the clinical and laboratory features of patients with relapsing episodes of CAPS. METHODS: Three patients with relapsing CAPS are presented with their clinical and laboratory features. RESULTS: Seven episodes of CAPS that occurred in the 3 patients reported were analyzed. The median time between the episodes of CAPS was 12.5 months (range, 2.5-48). Precipitating factors were identified in 2 episodes only (Legionella respiratory tract infection and periodontal infection). The most significant manifestations of the episodes were renal involvement (5 episodes), central nervous system and cardiac involvement (4 episodes), and pulmonary and hepatic involvement (3 episodes each). Interestingly, laboratory features of definite microangiopathic hemolytic anemia (MHA) were present in 5 of 7 episodes of relapsing CAPS. The remaining episodes presented with thrombocytopenia, schistocytes, and anemia but data concerning hemolysis and Coombs tests were not reported. Rituximab was used in 2 episodes. CONCLUSIONS: Relapses occur very infrequently in patients with the CAPS. The presence of MHA is common in these patients, suggesting that an association between MHA and relapses of CAPS could be present and that a "continuum" between various MHAs might exist, as recently suggested.