加味当归补血汤对肾虚血瘀型IgA肾病的疗效与对免疫功能的影响

目的:观察加味当归补血汤治疗肾虚血瘀性IgA肾病的临床疗效及对患者免疫系统的影响,分析其预后并探讨其相关机制。方法:选取2010年1月至2012年1月陕西中医肝肾病医院肾内科门诊及住院的肾虚血瘀型IgA肾病患者126例。按照随机数表法将患者分别纳入对照组和观察组,各63例,对照组在基础治疗上使用科素亚50 mg/d,观察组在对照组基础上加以口服汤剂加味当归补血汤。分别检测治疗前后患者24 h尿蛋白量、尿红细胞计数及血肌酐、血清IgA及T淋巴细胞亚群CD4~+/CD8~+值,同时进行肾穿刺活检,评估肾小球病变病理评分,比较2组临床疗效及预后。结果:经治疗后,2组24 h尿蛋白定量、尿红细胞计数、血肌酐较治疗前明显降低(P0.05),2组CD4~+/CD8~+、血清IgA值均降低(P0.05),且观察组优于对照组(P0.05),2组临床疗效进行比较,观察组总有效率(93.44%)优于对照组(83.33%)(P0.05)。随访后,2组预后分析中1年肾存活率差异无统计学意义(P0.05),3年、5年肾存活率观察组明显优于对照组(P0.05)。结论:加味当归补血汤可以增加治疗肾虚血瘀型IgA肾病患者的临床效果,提高IgA肾病患者的免疫功能,提高生存率,改善预后。     

桂枝加黄芪汤对肺气虚寒型变应性鼻炎的疗效及部分机制分析

目的:观察桂枝加黄芪汤对肺气虚寒型变应性鼻炎的临床疗效,并探讨其部分作用机制。方法:选取2012年1月至2014年6月我院收治的134例肺经寒型变应性鼻炎患者纳入研究,随机分为对照组和观察组,每组67例。其中对照组患者接受常规曲安奈德鼻喷剂法,1次/d,患者接受与对照组相同的常规治疗方法,同时加服桂枝加黄芪汤加减,1剂/d,分2次,100 m L/次,温服,所有患者均治疗3个疗程,每个疗程为20 d,比较治疗前后患者鼻部症状评分、外周血T淋巴细胞亚群水平变化。结果:1)经过治疗后其中观察组临床总有效率为90.79%,与对照组的73.68%比较,差异有统计学意义(P0.05)。观察组优于对照组。针对临床症状评分方面,2组治疗后临床症状平均均有所下降,其中观察组下降的趋势更为明显;2)对照组治疗后CD4~+、CD4~+/CD8~+升高,但与治疗前比较差异无统计学意义(P0.05),治疗组治疗后CD4~+、CD4~+/CD8~+升高,且与治疗前比较,差异有统计学意义(P0.05);治疗后2组的CD8~+均相比之前下降(均P0.05);治疗后治疗组和对照组的CD4~+、CD8~+、CD4~+/CD8~+组间比较差异有统计学意义(P0.05),治疗组改善优于对照组。3)与治疗前比较,2组治疗后患者的Ig A、Ig G、Ig M表达水平均明显降低(P0.05);2组患者治疗后相比,观察组的Ig A、Ig G、Ig M表达水平明显低于对照组(P0.05)。结论:黄芪加桂枝汤对肺气虚寒型变应性鼻炎性反应状有明显改善症状,与其作用机制可能与改善患者免疫力有关。     

米烈汉治疗亚急性甲状腺炎经验

介绍米烈汉教授治疗亚急性甲状腺炎的经验。米教授认为亚急性甲状腺炎总体属肝失疏泄、气机郁滞而致痰凝血瘀,郁久化火,痰热瘀血相搏,结于颈部而致,治疗以疏肝散结、化痰消痈为根本大法,自拟消瘿汤治疗。并附验案1则,以资佐证。     

针灸治疗心律失常质量评价

目的:采用STRICTA标准和CONSORT声明评价国内临床随机对照试验质量关于心律失常使用的针灸疗法。方法:使用计算机检索与手工检索,检索中国知网(CNKI),中国生物医学文献数据库(CBM),万方,维普(VIP)等数据库,另外采用手工检索,筛选出符合标准的文献,使用STRICTA标准和CONSORT声明进行质量评价。结果:纳入合格文献共计16篇,这些文献存在一定问题,例如:随机方法描述不具体;很少使用盲法;样本量计算少;针刺细节报道不充分;无意向治疗分析或针刺治疗医生的资历无报道等。结论:目前针灸治疗心律失常的临床试验质量偏低,文章的同质可比性以及可靠性受到影响,将CONSORT声明与STRICTA标准在临床执行,可以提高针灸临床随机试验的质量。     

长效抗凝血杀鼠药中毒 15 例临床分析

报道15例长效抗凝血杀鼠药急性中毒患者的临床表现、实验室检查、诊疗经过并加以分析讨论。     

婴幼儿泌尿道感染的诊治现状

在儿童中,尤其是婴幼儿中,泌尿道感染(UTI)是较为常见的感染性疾病之一。由于临床表现不典型,常引起漏诊及误诊,从而导致急性期死亡,并且婴幼儿UTI容易反复,进而造成肾损害,导致肾瘢痕形成,甚至进一步发展为蛋白尿、高血压及肾功能不全。因此,早期诊断、有效的抗生素治疗、及时评估、治疗潜在疾病,能够有效地降低死亡率,防止并发症的发生。该文总结了近年来国内外相关文献,以期为婴幼儿UTI的诊治提供临床参考。     

儿童气管支气管异物延误诊断的原因及影响分析

目的探讨儿童气管支气管异物延误诊断的原因及影响,为进一步提高对该病的认识提供临床依据。方法选取2016年1月1日至2017年12月31日在西安市儿童医院呼吸一科因气管支气管异物住院的患儿342例,在患儿呛咳或出现症状后,≤7天确诊为早期诊断组(228例),>7天确诊则为延误诊断组(114例),对其临床资料进行回顾性分析。结果患儿发病年龄集中在≥1~<3岁(85.7%),男∶女=2∶1,植物性异物占绝大多数(90.4%),1、2月份气管支气管异物发病率较高,分别为10.2%,14.9%。与早期诊断组相比,延误诊断组患儿来自农村的比例及病程中发热的比例均明显升高(χ~2值分别为6.637、42.092,均P<0.05),院外接受抗生素或激素治疗比例、无并发症比例均显著增高(χ~2值分别为129.848、10.206,均P<0.01),住院时间明显延长(t=-4.470,P<0.01),家属提供呛咳史的比例明显减少(χ~2=43.589,P<0.01)。结论患儿家长未主动提供呛咳病史、医生的诊断意识不够、不恰当地使用抗生素或激素是造成延误诊断的主要原因,延误诊断可增加肺气肿、肺炎、肺不张等并发症发生,对反复呼吸道感染、慢性咳嗽、反复喘息的患儿应酌情考虑行支气管镜检查。     

葡萄球菌性烫伤样皮肤综合征23例临床分析

目的　了解葡萄球菌性烫伤样皮肤综合征 (SSSS)的发病情况。方法　对诊断明确的 2 3例患者的诱因、临床表现、并发症、治疗及预后进行分析。结果　 19例发病前有诱因 ;17例伴发热 ,高热 4例 ;16例WBC升高 ;17例在 7～ 10天内治愈出院 ;顿挫型 1例。结论　SSSS全年各季均有发病 ,有较大的儿童患病 ,发病前常有明显感染史。身体抵抗力降低与本病发生有关。     

雄激素对HIBD新生大鼠脑保护作用的量效关系及副作用研究

目的 探讨雄激素对HIBD新生大鼠脑保护作用及量效关系,初步揭示雄激素的远期副作用.方法 3日龄SD大鼠72只随机分为:假手术组(n=8)、HIBD对照组(n=32)、雄激素组(n=32).雄激素组和HIBD对照组各分为4个剂量组,每个剂量组8只.3日龄时雄激素组每个剂量组每只大鼠分别腹腔注射30 mg/kg、60 mg/kg、120 mg/kg和240 mg/kg的丙酸睾酮,HIBD对照组每个剂量组每只大鼠腹腔注射相应毫升数的花生油,每日1次,连续3 d.7日龄时雄激素组和HIBD对照组制作HIBD模型.所有动物饲养至成年后进行水迷宫实验以测定空间学习记忆能力;成年雌鼠每日做阴道涂片,明确每只大鼠的完整发情周期,对于处于发情期的雌鼠及时与雄鼠合笼,次日晨雌鼠做阴道细胞涂片检查,并观察有无阴栓,以查到精子或观察到阴栓作为受孕成功标志,记录各组雌鼠的妊娠率以及妊娠胚胎数目,进行统计学处理,比较组间差异.计算成年雄鼠睾丸系数和附睾系数.结果 水迷宫实验中,HIBD对照组较假手术组平均潜伏期(27.71±3.19)s和首次穿越平台时间(5.34±0.83)s明显延长,HIBD对照组较假手术组穿越目标象限次数(18.88±1.89)明显减少,均有统计学意义(P均＜0.01,P=0.0005＝.雄激素组中各相应剂量组平均潜伏期(34.89±3.68,33.71±3.38,33.84±3.45,35.43±2.43)和首次穿越平台时间(5.39±1.51,6.28±2.07,5.09±1.61,5.85±0.87)较HIBD对照组明显缩短,穿越目标象限次数(12.75±2.05,14.88±3.36,14.88±2.36,14.38±1.60)较HIBD对照组明显增加,均有统计学意义(P均＜0.01,P=0.0001＝.雄激素组各剂量组以上指标相比均无统计学意义(P均＞0.05,P=0.159).雄激素各剂量组雄性大鼠睾丸系数(0.89 ±0.07,0.92±0.08,0.88±0.11,0.87±0.09)和附睾系数(0.25±0.02,0.24±0.05,0.26±0.04,0.23 ±0.05)与假手术组和HIBD组相比,差异均无统计学意义(P＞均0.05,P=3.207),雄激素组各剂量组间相比无统计学差异(P＞0.05,P=6.663);雄激素各剂量组雌性大鼠的怀孕率(均100%)及妊娠胚胎数(14.52±3.34,14.69±2.28,14.98±2.67,15.38±3.07)与假手术组和HIBD组相比,差异均无统计学意义(P＞0.05,P=5.085).结论 HIBD对大鼠的空间学习记忆能力有影响,可降低其空间学习记忆能力.雄激素干预后可明显降低HIBD对大鼠学习记忆能力的影响.雄激素的早期干预对成年后大鼠的生殖能力无影响.

Abstract：

Objective To explore brain-protective effect of androgen, its dose-effect relationship and long-term adverse reaction. Method Seventy two 3-day-old SD rats were randomized into androgen group( n = 32) , HIBD model group ( n = 32 ) and sham operated group ( n = 8 ). The androgen group and HIBD model group were further randomized into 30 mg/kg group, 60 mg/kg group, 120 mg/kg group and 240 mg/kg group, respectively. In androgen group and HIBD group, every rat was given testosterone or peanut oil, one time a day. Three days later, HIBD model was established by occlusion of the left common carotid artery and inhalation of 8% oxygen plus 92% nitrogen for 2.5 hours. Adult rats' ability of learningand memory was determined by water maze test. Escape latencies were recorded and analyzed by statistics.Vaginal cells of all female rats were examined everyday for identifying their estrous cycle. Female rats were allowed to live with normal adult male rats if the female rats were in estrous period. Vaginal cells were examined everyday until sperm was seen, which was the signal of gestation. Pregnancy rate and the number of embryos were recorded and analyzed by statistics. Acropetal coefficient was calculated. The testes and epididymis were taken from adult male rats, histopathological sections were made, and the structure of testis and epididymis were studied under light microscope. Result In Morris experiment, escape latencies (EL)of HIBD group were much longer than those of sham operation group( 27.71 ± 3.19)s, time of first enter target ( 1st ET) was later than that of sham operation group(5.34 ±0.83)s, times of target cross (TC) was less than that of sham operation group ( 18.88 ± 1.89 ) ( P ＜ 0.01, P = 0. 0005 ). EL of androgen group (34.89 ± 3.68,33.71 ± 3.38,33.84 ± 3.45, 35.43 ± 2.43 ) were much shorter than that of HIBD group,1st ET (5.39 ± 1.51,6.28 ±2.07,5.09 ± 1.61, 5.85 ±0.87)was earlier than that of HIBD group, TC ( 12.75 ± 2.05,14.88 ± 3.36,14.88 ± 2.36,14.38 ± 1.60) was more than that of HIBD group ( P ＜ 0.01,P=0.0001). Among the four doses groups of androgen group, EL, 1st ET and TC had no statistical significance (P ＞0.05, P =0.159). There were no statistical significance between male rats of androgen group [Testes acropetal coefficient ( 0.89 ± 0.07,0.92 ± 0.08, 0.88 ± 0.11,0.87 ± 0.09 ), epididymis acropetal coefficient ( 0.25 ± 0.02,0.24 ± 0.05,0.26 ± 0.04,0.23 ± 0.05 )], HIBD group and sham operation group( P ＞ 0.05, P = 3.207 ). Among the four doses groups of androgen group had no statistical significance ( P ＞ 0.05, P = 6.663 ). There were no statistical significance between female rats of androgen group( pregnancy rate, 100%; times, 14.52 ± 3.34,14.69 ± 2.28,14.98 ± 2. 67, 15.38 ± 3.07 ), HIBD group and sham operation group in pregnancy rate and times. Conclusion The intellectual ability of rats decreased after HI. Androgen could reduce the effect of HI on intellectual ability. Androgen had no adverse reaction to the reproductive capacity of adult rats.