Treatment of Heroinism with Acupuncture at Points of the Du Channel

To observe the effectiveness of acupuncture at points of the Du Channel in treating heroinism, seventy patients with heroinism were randomly divided into a treatment group （n = 35） and a control group （n=35）. A 10-day decrescendo therapy of methadone and acupuncture at points of the Du Channel were adopted in the treatment group, while the 10-day decrescendo therapy of methadone was simply performed in the control group. The scoring and grading of the abstinence symptoms were recorded and evaluated for both groups. 31 cases in the treatment group and 26 cases in the control group completed the entire treatment process, and a significant difference （P〈0.01） in scores of abstinence symptoms before and after treatment was noticed in the two groups. The obvious difference in scores of abstinence symptoms on the first, second, fifth, sixth, seventh, eighth, ninth and tenth day in the treatment group was superior to those in the control group （P〈0.05 or P〈0.01）. Particularly for such symptoms as perspiration, anxiety and pain in the muscle and bone, the result in the treatment group was much better than that in the control group （P〈0.05 or P〈0.01）. Acupuncture at points of the Du Channel has an auxiliary therapeutic effect on abstinence symptoms of heroinism, which can effectively help alleviate the abstinence symptoms.     

Effect of Zhubin (KI9) Acupuncture in Reducing Alcohol Craving in Patients with Alcohol Dependence: A Randomized Placebo-Controlled Trial

Objective:To examine the effect of acupuncture on Zhubin(KI9) in reducing alcohol craving in alcohol-dependent patients.Methods:Twenty male alcohol-dependent patients were randomly assigned to two groups,a treatment group(10 cases,age 43.0 ±6.8 years) and a placebo group(10 cases,age 44.5 ±7.9years).The treatment group was treated with real needle acupuncture on Zhubin(KI9) twice a week for 4 weeks,and the control group was treated with placebo needle acupuncture.Both groups were given acupuncture treatment using Park Sham Device(PSD).Alcohol craving was measured by the Visual Analogue Scale(VAS)before treatment to establish a baseline,and after 1,2,and 4 weeks of treatment.Repeated measures ANOVA was used to determine the main and interaction effects of time and on the outcome measure(VAS).Results:There was a significant effect of time on VAS score(df=3,F=13.3,P0.01).Main effect of group on VAS score was significant(df=1,F=10.9,P0.01) and the time x group interaction was also significant(df=3,F=4.7,P0.01).Conclusions:Real-needle acupuncture therapy on Zhubin(KI9) showed effectiveness in reducing alcohol craving.These results strongly suggest the usefulness of acupuncture therapy on Zhubin(KI9) in preventing a relapse in alcohol dependent patients.     

Gender based differences in patients with acute coronary syndrome: findings from Chinese Registry of Acute Coronary Events (CRACE)

Background Many studies have examined gender related differences in the presenting symptoms, management and prognosis of patients with acute coronary syndrome (ACS). Much data are available from industrialized countries, in which ACS is a major cause of morbidity and mortality, but relatively little information has been obtained from China, where an epidemic of cardiovascular disease is starting to emerge. The purpose of this study was to assess the differences in clinical practice in a national Chinese sample.Methods A total of 12 medical teaching hospitals participated in CRACE. Data collection began in 2001 and continued until 2004, 1301 patients with ACS were enrolled into the study. We compared the clinical demographics, different therapies and outcomes in hospitals between female and male patients with ACS.Results Patients had an average age of 63.13 years (ranging from 27 to 93 years) and 318 female and 983 male subjects were enrolled. Female subjects were older than male patients (67.23 years vs 61.80 years, P<0.0001). The incidence of angina, heart failure, diabetes mellitus and hypertension in the female group was higher than in male group (73.6% vs 62.3%, P<0.0001; 8.2% vs 5.7%, P=0.031; 30.8% vs 18.6%, P<0.0001 and 66.4% vs 56.8%, P=0.001 respectively), but the incidence of smoking was less in the female group than in the male group (6.6% vs 66.2%, P<0.0001). More male patients presented with ST-segment elevation myocardial infarction (STEMI) compared with female patients (48.5% vs 39%, P=0.002). With the exception of β-blocker administration, no differences were found among medications including aspirin, ACEI, lipid lowering agents and low-molecular-weight heparin (LMWH) between female and male patients presenting with ACS in hospitals. Compared with male patients with non-ST-segment elevation (NSTE) ACS, female subjects were more prone to receive β-blockers (75.1% vs 63.4%, P=0.001). Among STEMI and NSTE-ACS patients, fewer female subjects received reperfusion therapy compared with male subjects (37.1% vs 26.8%, P=0.013 for STEMI; 53.6% vs 37.2 %, P<0.0001 for NSTE-ACS). Recurrent angina was more often seen in the female group of patients with the whole spectrum of ACS (25% vs 14.5%, P=0.005 for STEMI; 29.4% vs 20.2%, P=0.001 for NSTE-ACS) as was true for patients with congestive heart failure. There was no significant difference in in-hospital death rates between the two groups with ACS (5.6% vs 7.1%, P=0.2 for STEMI, and 2.1% vs 1.4%, P=0.738 for NSTE-ACS). Conclusions Female patients with ACS were older than male subjects and thus more often had concomitant diseases but less often had a history of smoking. They less often received reperfusion therapies and more often had higher in-hospital recurrent angina. However, there was no significant difference in in-hospital mortality between the female and male patients.     

Intervention Effect of Jianxin Decoction（健心汤） on Serum Cytokine Level of Congestive Heart Failure Patients

Objective: To investigate the intervention effect of Jianxin Decoction (健心汤, JXD) on the cytokine level in serum of patients with congestive heart failure (CHF). Methods: Sixty-six patients with CHF were randomly divided into the control group (n=33) and the trial group (n=33). The control group received conventional treatment, and the trial group was treated with conventional therapy plus JXD for 4weeks. Before and after treatment, tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and nitrogen monoxide (NO) in serum and cardiac function were determined. Results: After treatment, the levels of TNF-α,IL-6 and NO were significantly lower than those before treatment (P＜0.05, or P＜0. 01) in the two groups,and the lowering degree of the indices in the trial group was more significantly reduced than that in the control group (P＜0. 05). And cardiac functions in both groups were improved significantly (P ＜ 0.05, or P ＜0.01). Conclusion: JXD could prevent and reverse ventricular remodeling so as to ameliorate cardiac function through regulating the levels of cytokines.     

Chinese Medicine for Outcomes in Colorectal Cancer Patients: A Retrospective Clinical Study

Objective: To investigate the effect of Chinese medicine(CM) on survival of patients with stage Ⅱ and Ⅲ colorectal cancer(CRC). Methods: A total of 295 patients who received chemotherapy were assigned to Group 1. The other 171 patients received the same chemotherapy treatment combined with the usage of CM Jianpi Jiedu Formula(健脾解毒方, JPJD) for more than 3 months(Group 2). Patients' survival time, relapse and metastasis, and cause of death were observed. Cox proportional hazard regression models were established for the analysis of the effect of independent factors on the survival prognosis of patients with CRC. Results: The survival rate of patients in Group 2 was higher than that of Group 1(P0.05). Compared with Group 1, the mean survival time was prolonged by 5.594 months and the median survival time was prolonged by 6 months in Group 2(P=0.004). Cox regression analysis indicated that CM combined with chemotherapy provided significant protective effect, as observed with the improvements in the survival rates of CRC patients(P0.01). Conclusion: CM can improve the survival rate in patients with stage Ⅱ and Ⅲ CRC.     

依恋、社会支持、应对方式在生活事件影响心理健康的中介作用

Objective To study the effect of attachment, coping style and social support on mental health in technical school students.Methods 372 technical school students were assessed by ECR(Experiences in Close Relationship's Inventory) ,Symptom Check Scale List-90 (SCL-90) and Coping Style Scale For Secondary School Students( CSS), Adolescent Self-Rating Life Events Checklist ( ASLEC), Perceived Social Support Scale (PSSS).Results ( 1 ) Life events had significant correlations with all indexes score of attachment anxiety ( r =0.293 ～ 0.356, P ＜0.01 ) ,the scale of coping style focus on emotion and the total score of SCL-90 ( r = 0.259 ～0.509, P＜0.01 ) ,and the total score of perceived social support had significant correlations with the total score of SCL-90 ( r =-0.238, P ＜ 0.01 ).( 2 ) Structural equation analysis ( model fit: χ2 = 540.593, RMSEA = 0.114,NFI = 0.864 ,CFI =0.884, P ＜ 0.01 ) showed that life events affect on mental health through the mediation effects of coping style focus on emotion, attachment anxiety and the perceived social support and coping style focus on emotion had most mediating effect on mental health ( mediation effect = 33.2% ).Conclusion Life events had both direct effect and indirect effect through coping style focus on emotion, attachment anxiety and the Perceived Social Support on mental health.     

Effect of Xin''''anning Nasal Drop ( 心安宁滴鼻剂 ) in Treating Coronary Heart Disease with Unstable Angina Pectoris

Objective: To observe the clinical efficacy of Xin'anning Nasal Drop (XAND, 心安宁滴鼻剂 )in treating coronary heart disease with unstable angina pectoris (CHD-UAP). Methods: Sixty patients with CHD-UAP were assigned, according to the randomizing number table, to two groups, the control group treated with conventional Western medicine, and the treated group treated with conventional Western medicine plus XAND. The clinical efficacy and the changes of S-T segment in resting EKG and total ischemia burden (TIB) in 24-h dynamic EKG were observed. Results: The clinical efficacy, including the effect of angina alleviation, its initiation, and the effect of TCM syndrome score reduction, were significantly superior in the treated group to those in the control group ( P＜0.05 or P＜0.01 ). The degree and extent of myocardial ischemia were significantly improved in both groups ( P＜0.01 ), but the improvement in the treated group was better than that in the control group ( P＜0.05). Moreover, it was worth mentioning that the immediate effect in the treated group was better than that in the control group, and the reduction of TIB, the improvement in heart rate and myocardial oxygen consumption (immediately after the first administration or by the end of the therapeutic course), and systolic blood pressure after treatment in the former were all superior to those in the latter, showing significant difference ( P＜0.05 or P＜0. 01 ). Conclusion: XAND has a quick effect in alleviating angina in patients with CHD-UAP, and it is worthy of further studies and spreading in clinical practice.     

Heroin abuse and nitric oxide, oxidation, peroxidation, lipoperoxidation

To further reveal the risks of heroin abuse to human body, and to determine the injuries of oxidation, peroxidation and lipoperoxidation induced by nitric oxide and other free radicals to heroin abusers, we determined and compared plasma values of lipoperoxides (LPO), nitric oxide (NO), vitamin C (VC), vitamin E (VE), β-carotene (β-CAR) and erythrocyte values of LPO, superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GSH-Px) in 114 heroin abusers and 100 healthy volunteers. Using linear regression and correlation as well as stepwise regression and correlation, we also analyzed the effect of the abusing duration, and daily abusing quantity on the above-mentioned biochemical parameters in the heroin abusers. The results showed that, compared with the healthy volunteer groups, the average plasma values of LPO, and NO, and the average erythrocyte value of LPO in the heroin abuser group were significantly increased (P＜0.0001), and the average plasma values of VC, VE, and β-CAR and the average erythrocyte values of SOD, CAT, and GSH-Px were significantly decreased (P＜0.0001). Analysis of linear regression and correlation showed that with prolonged heroin abusing and with increased daily quantity in the heroin abusers, the plasma values of LPO, and NO, and the erythrocyte value of LPO were gradually increased (P＜0.001), whereas the plasma values of VC, VE, and β-CAR and the erythrocyte values of SOD, CAT, and GSH-Px were gradually decreased (P＜0.001). Analysis of stepwise regression and correlation indicated that the plasma values of NO, VC and VE were closely correlated with the abusing duration and daily abusing quantity. These results indicate that the balance between oxidation and antioxidation in the heroin abusers was seriously disturbed, and the injuries induced by nitric oxide and other free radicals, through oxidation, peroxidation and lipoperoxidation to the bodies of heroin abusers exacerbated. It is therefore necessary that in abstaining from heroin dependence, the heroin abusers should acquire sufficient quantities of antioxidants such as VC, VE and β-CAR.     

Efficacy of Valerian Extract on Sleep Quality after Coronary Artery bypass Graft Surgery: A Triple-Blind Randomized Controlled Trial

Objective:To assess the effect of valerian root extract on the sleep quality of patients after coronary artery bypass graft(CABG)surgery.Methods:The patients who participated in this triple-blind clinical trial were selected by permuted block randomization.The participants were assigned to the valerian(n=36)and placebo(n=36)groups.The valerian group received 530 mg of valerian capsules for 30 nights after CABG surgery,and the placebo group received 530 mg of the placebo capsules containing wheat flour.The Pittsburgh Sleep Quality Index(PSQI),the prothrombin time(PT)and partial thromboplastin time(PTT)were assessed on four occasions,including the baseline,the 3 rd,14 th and 30 th days following intervention.Results:The odds ratio of worsened sleep quality significantly varied over time(the interaction of time and group)in the valerian group compared to the placebo group in various dimensions including total sleep quality(P=0.001),sleep latency(P<0.01),sleep duration(P=0.020),sleep efficiency(P=0.001)and daytime dysfunction(P=0.025).No significant difference was observed in the alterations of the odds ratio of PT in the two groups over time.(P=0.371).Conclusion:The consumption of oral valerian root extract over 30 nights could significantly improve the patients'sleep quality safely after CABG surgery.     

依恋、社会支持、应对方式在生活事件影响心理健康的中介作用

Objective To study the effect of attachment, coping style and social support on mental health in technical school students.Methods 372 technical school students were assessed by ECR(Experiences in Close Relationship's Inventory) ,Symptom Check Scale List-90 (SCL-90) and Coping Style Scale For Secondary School Students( CSS), Adolescent Self-Rating Life Events Checklist ( ASLEC), Perceived Social Support Scale (PSSS).Results ( 1 ) Life events had significant correlations with all indexes score of attachment anxiety ( r =0.293 ～ 0.356, P ＜0.01 ) ,the scale of coping style focus on emotion and the total score of SCL-90 ( r = 0.259 ～0.509, P＜0.01 ) ,and the total score of perceived social support had significant correlations with the total score of SCL-90 ( r =-0.238, P ＜ 0.01 ).( 2 ) Structural equation analysis ( model fit: χ2 = 540.593, RMSEA = 0.114,NFI = 0.864 ,CFI =0.884, P ＜ 0.01 ) showed that life events affect on mental health through the mediation effects of coping style focus on emotion, attachment anxiety and the perceived social support and coping style focus on emotion had most mediating effect on mental health ( mediation effect = 33.2% ).Conclusion Life events had both direct effect and indirect effect through coping style focus on emotion, attachment anxiety and the Perceived Social Support on mental health.     

帕金森病患者的决策认知障碍

目的 探讨帕金森病(PD)患者的社会决策认知能力.方法 将20例首发PD患者以及与其人口学资料相匹配的健康对照组(HC)作为研究对象,采用爱荷华博弈任务(Iowa Gambling Task)进行社会决策行为能力的测试.采用Hoehn-Yahr分级量表对PD患者的严重程度进行评定.结果 与HC组相比,PD组不仅存在词汇流畅性以及数字广度障碍,而且存在决策认知障碍.在博弈任务中,PD组的总不利选择次数明显高于HC组(分别为51.6±5.8,46.8±8.2),差异有统计学意义[t_(38)=2.12,P=0.04].采用2(组)×5(阶段)的方差分析比较两组不同阶段的总有利选择,结果 发现,2组间的主效应显著[F_(1,38)=6.16,P=0.01];不同阶段的主效应亦显著[F_(4,152)=2.43,P=0.04].随着博弈任务卡片选择次数的增多,HC组有利选择次数逐渐增加;而帕金森病患者却不具有此种稳定的决策行为模式.同时研究还表明,PD患者的总不利选择次数与患者的疾病严重程度呈正相关(r=0.52;P＜0.05).结论 PD患者存在决策认知功能障碍,而这种社会决策障碍可能与前额叶眶面功能异常有关.     

美沙酮维持治疗门诊患者HCV感染状况分析

目的了解美沙酮维持治疗(MMT)门诊患者的丙型肝炎病毒(HCV)感染状况,为相应的疾病控制干预提供依据。方法对153名接受MMT治疗的患者采静脉血进行HCV抗体检测。结果 153例接受(MMT)的门诊患者中HCV抗体阳性率69.28%(106/153),明显高于我国普通人群的平均感染率3.20%,差异具有统计学意义(χ2=107.64,P<0.001)。MMT门诊患者男、女HCV抗体阳性率分别为66.67%(64/96)和73.68%(42/57),男、女性别差异无统计学意义(χ=0.83,P>0.05)。经注射给药的海洛因依赖者的HCV抗体阳性率89.01%(81/91),明显高于其他途径给药的海洛因依赖患者40.32%(25/62),两者比较差异具有统计学意义(χ2=41.07,P<0.001)。不同给药途径的海洛因依赖人群丙肝HCV感染男、女性别差异无统计学意义(P>0.05)。结论美沙酮维持治疗(MMT)门诊患者丙型肝炎病毒(HCV)感染率较高,尤其是注射给药的海洛因依赖者。应加强对丙型肝炎的有效防治。     

对美沙酮维持治疗者进行健康教育的探讨

目的：寻求有效的健康教育方法,使美沙酮维持治疗（MMT）患者参加美沙酮维持治疗的依从性提高,降低复吸率.方法：通过对2006年7月-2013年6月本门诊收治的1 542例患者资料进行回顾,其中男性1 192例,女性350例,从中随机抽取710名患者,分成两组,其中320名为对照组不进行健康教育,390名为观察组进行健康教育.6个月以后对两组患者的维持率与尿检阳性率进行对比.结果：对照组的维持治疗率和尿检阳性率都比观察组差（P〈0.01）.结论：对患者和家属提供健康教育,增强患者与家属对美沙酮维持治疗的认识及参与治疗的积极性.使患者依附性增加,脱失率下降,最终完全停止海洛因的使用,真正回归社会是有明显效果的.     

美沙酮维持治疗海洛因依赖患者的孤独感与疼痛的相互关系

目的 分析美沙酮维持治疗(MMT)海洛因依赖患者(HDPs)的孤独感与疼痛的相互关系.方法 603例MMT门诊HDPs完成一般情况问卷、抑郁自评量表、焦虑自评量表、单一条目孤独感自评问卷和五点口述分级评分疼痛强度自评问题.用有序因变量Logistic回归分析孤独感与疼痛的双向联系.结果 孤独感与疼痛强度评分呈中度显著正相关性(r =0.453,P＜0.001).控制社会人口学因素、物质使用特征变量、抑郁症状和焦虑症状的潜在混杂效应后,疼痛强度增加与孤独感风险上升呈显著相关性(OR=1.53,P＜0.001),孤独感水平升高也与疼痛强度增加呈显著相关性(OR=1.22,P＜0.042).结论 MMT 门 诊HDPs的孤独感与疼痛存在双向作用,社会心理干预配合合适的疼痛管理有利于HDPs的全面康复.     

美沙酮维持治疗6个月后海洛因成瘾者渴求程度变化及影响因素分析

目的：探讨美沙酮维持治疗患者接受治疗6个月后对海洛因渴求程度的改变情况以及影响渴求改变的可能因素。方法：采用《海洛因渴求问卷》分别在患者入组治疗时、治疗后6个月随访调查,分析美沙酮维持治疗前后患者对海洛因等毒品的渴求程度以及影响渴求程度改变的因素。结果：治疗6个月后患者除自我控制因子外,渴求总分及其他各因子分均低于基线入组时;高剂量组的美沙酮患者治疗后渴求程度降低明显（P<0.05）。男、女患者接受治疗后渴求程度均有下降,但差异无统计学意义（P>0.05）。吸毒年限长的患者渴求水平高于吸毒年限短的患者,接受治疗后渴求程度改善较吸毒年限短的患者明显。结论：美沙酮维持治疗能够减少海洛因成瘾者对海洛因的渴求。美沙酮剂量、患者性别是影响渴求改变的可能因素。     

美沙酮联合氯氮平治疗海洛因依赖的临床对照研究

目的：探讨美沙酮联合氯氮平治疗海洛因依赖的疗效及安全性。方法：将60例自愿戒毒的海洛因依赖者随机分为研究组30例和对照组30例。分别于治疗前及治疗后采用汉密尔顿焦虑量表和副反应量表评定临床疗效和不良反应。结果：两组治疗前后汉密尔顿焦虑量表评分比较有非常显著性差异（P〈0．01）。结论：美沙酮联合氯氮平治疗海洛因依赖疗效肯定，安全性高。     

美沙酮维持治疗者中枢神经递质功能的变化

目的 检测美沙酮维持治疗（methadone maintenance treatment,MMT）患者脑神经递质功能及脑功能指数,了解其大脑功能的变化特点.方法 应用脑涨落图仪（EFG）采集58例MMT患者及44例健康成年人的脑电功率信号,分析MMT患者脑神经递质变化的特点及各神经递质与脑功能状态的相关性.结果 （1）与对照组相比,MMT组的神经递质实测功率普遍降低,其中γ-氨基丁酸（GABA）[（17.73±3.54）μV2 vs.（121.48±44.64） μV2,P＜0.01）、谷氨酸（Glu）[（42.18±12.84） μV2 vs.（105.31±34.95） μV2,P＜0.05]均差异有统计学意义.（2） MMT组的GABA[（17.10±51.72）μV2 vs.（78.67±10.93） μV2,P＜0.001]、Glu[（30.48±21.61） μV2 vs.（69.23±42.26） μV2,P＜0.001]相对功率降低,差异有统计学意义;而五羟色胺（5-HT）[（297.18±31.54）μV2 vs.（280.18±31.54） μV2,P＜0.01]、乙酰胆碱（Ach）[（235.08±37.72） μV2 vs.（217.23±40.60） μV2,P＜0.05]、去甲肾上腺素（NE）[（164.11±33.05） μV2 vs （146.39±30.80） μV2,P＜0.01]、多巴胺（DA）[（98.87±22.48） μV2 vs.（91.49±21.04） μV2,P＜0.05]则升高,均差异有统计学意义;（3） MMT组的全脑总功率低于对照组[（1012.01±195.09） μV2 vs.（1775.94±458.99） μV2,P＜0.01],差异有统计学意义;兴奋抑制指数（2.19±1.46 vs.0.99±0.47,P＜0.001）及相对熵[（89.45±9.71）％ vs.（75.48±9.97）％,P＜0.01]高于对照组,均差异有统计学意义;（4）MMT组各种神经递质功率与全脑总功率均具有正相关,均差异有统计学意义（P＜0.001）,Glu与兴奋抑制指数（r=0.264,P＜0.05）、NE与血管舒缩指数则有正相关,均差异有统计学意义（r=0.269,P＜0.05）,5-HT（r=-0.276,P＜0.05）和DA（r=-0.375,P＜0.01）分别与相对熵存在负相关,均差异有统计学意义.结论 MMT患者的大脑功能显著降低,神经递质的兴奋性和抑制性明显失衡.     

美沙酮维持治疗者脱失的影响因素单中心调查分析

目的分析单中心美沙酮维持治疗者脱失的资料,探讨治疗脱失相关影响因素。方法样本来源于上海市虹口区精神卫生中心美沙酮维持治疗门诊的海洛因依赖者。研究组(n=54)为服药时间不足3个月退出治疗者,对照组(n=107)为服药时间超过6个月仍在维持治疗者。调查两组研究对象的社会人口学特征、成瘾程度、戒毒治疗、应对方式、社会支持等情况,分析各种潜在因素对海洛因依赖患者美沙酮维持治疗依从性的影响。结果对维持治疗的认识缺乏、低积极应对水平、高消极应对水平、社会支持差是影响美沙酮维持治疗脱失的危险因素。结论应针对危险因素实施综合干预,降低美沙酮维持患者的脱失率。     

海洛因依赖者在美沙酮维持治疗前后多药滥用情况调查研究

目的:了解海洛因依赖者在美沙酮维持治疗前后多药滥用情况。方法:采用《药物滥用监测调查表》及《入组后药物滥用调查表》对海洛因依赖者入组前后进行问卷调查。结果:海洛因依赖者参加MMT前并用的毒品按使用频度递减分别是为:海洛因、安定、曲马多、冰毒、K粉、摇头丸、大麻、丁丙诺啡、三唑仑、麻谷、联邦止咳药水、度冷丁、可卡因;参加MMT后,除冰毒、麻谷、联邦止咳药、度冷丁、可卡因等五种毒品,其它毒品滥用的减少有明显差异;每月花费分别为(3030.00±1756.15)元、(118.54±56.37)元。结论:海洛因依赖者参加MMT后仍存在海洛因、安定、冰毒、麻谷等多药滥用现象,但合用毒品的种类、次数、花费明显减少。