白花香莲解毒颗粒联合恩替卡韦治疗HBeAg阳性慢性乙型肝炎的多中心、双盲对照研究

目的观察白花香莲解毒颗粒联合恩替卡韦治疗HBeAg阳性慢性乙型肝炎的临床疗效。方法选取2018年1月—2019年1月就诊于广西中医药大学第一附属医院、田东县中医医院、藤县中医医院、那坡县中医医院、南宁市武鸣区中医医院的HBeAg阳性慢性乙型肝炎患者320例,随机分为对照组和治疗组,每组各160例。对照组口服中药安慰剂,2袋/次,2次/d,同时餐前或餐后2h口服恩替卡韦分散片0.5mg/次,1次/d。治疗组在对照组服用恩替卡韦分散片基础上口服白花香莲解毒颗粒,2袋/次,2次/d。两组患者均治疗48周。观察两组患者临床疗效,同时比较治疗前后两组患者HBV DNA下降值、病毒应答率、HBVDNA转阴率、血清生化应答率、HBeAg转阴率、HBeAg血清转换率和症状积分。结果治疗后,对照组临床有效率为76.88%,显著低于治疗组的88.75%,两组比较差异有统计学意义(P0.05)。治疗24、48周时,治疗组症状积分与同组治疗前比较差异有统计学意义(P0.05),治疗组症状积分与对照组治疗同期比较差异有统计学意义(P0.05)。治疗12、24、48周时,两组HBVDNA下降值均较同组治疗前升高(P0.05)。治疗12、24、48周时,治疗组HBV DNA下降值显著高于对照组(P0.05)。治疗12、24周时,治疗组病毒应答率优于对照组(P0.05)。治疗12、24、48周时,治疗组HBVDNA转阴率、血清生化应答率均优于对照组(P0.05)。治疗48周时,治疗组HBeAg转阴率优于对照组(P0.05)。治疗24、48周时,治疗组HBeAg血清转换率优于对照组(P0.05)。结论白花香莲解毒颗粒能够显著提高HBV DNA转阴率,增加HBeAg血清学转换率,改善肝功能及临床症状。     

定喘止咳汤联合布地奈德混悬剂治疗婴幼儿喘息性支气管炎的疗效与安全性分析

目的:研究定喘止咳汤联合布地奈德混悬剂治疗婴幼儿喘息性支气管炎的疗效与安全性。方法:将2014年9月至2016年9月期间琼海市中医院儿科收治的喘息性支气管炎婴幼儿患者98例,随机分成观察组与对照组,每组49例,观察组采用定喘止咳汤联合布地奈德混悬剂治疗,对照组采用布地奈德混悬剂治疗,比较2组的疗效、症状缓解时间以及不良反应等。结果:观察组以及对照组治疗7 d后的总有效率分别为95.92%和83.67%,观察组明显的高于对照组,差异有统计学意义(P0.05);观察组患儿气喘、咳嗽以及肺部哮鸣音等临床症状的消失时间明显的短于对照组,差异有统计学意义(P0.05);治疗后,观察组的Rrs SO明显低于对照组,Crs SO明显高于对照组,差异有统计学意义(P0.05);观察组患儿3个月的复发率明显的低于对照组,比较差异有统计学意义(P0.05)。结论:定喘止咳汤联合布地奈德混悬剂促进了临床症状缓解,提高了治疗总有效率,降低了复发率,安全性高。     

A Sociological Analysis and Exploration of Factors Associated with Commercial Preparations of Smokeless Tobacco Use in Sri Lanka

Background: Use and addiction to commercial preparation of Smokeless Tobacco (CPSLT) is creating new socio-cultural issues and health challenges in Sri Lanka.  The objective of this sociological study is to investigate and analyse the socio-cultural factors that influence CPSLT use Sri Lanka to enable development of effective interventions.  Methods: This is a qualitative study for which data was collected through in-depth interviews in selected groups that use CPSLT. Thirty-five interviews were carried out in seven of the 24 districts in the country representing urban, rural, plantation communities and different livelihood and ethnic, gender and age groups in the year 2016. Purposive and snowball sampling techniques were used for selecting interviewees. The data was analysed by using qualitative data analysis techniques and sociological perspectives. Results: This study reveals that the CPSLT use has integrated with the culture of several sociological and livelihood groups. Products such Thool (tobacco powder) and Maawa (dried areca-nut with flaked tobacco and some flavoured chemicals) were identified as the most popular forms of CPSLT.  Use of CPSLT has developed as a silent sub-culture specific to several social and livelihood groups. The informal CPSLT industry operating in the urban and sub-urban areas is influencing the school children and youth engaged in sports. Different groups of users express different reasons and justifications for its use. Conclusion: Use of CPSLT is closely integrated with the day to-day lifestyle and values of people of specific groups. and is an unseen part of life. Therefore, interventions will be urgently required to control the use of CPSLT to prevent its significant health impacts, considering the different contexts, symbolisms and justifications of its among the different groups.     

四子散贴敷加清肺定喘汤联合西药治疗支气管哮喘随机平行对照研究

[目的]观察四子散贴敷加清肺定喘汤联合西药治疗支气管哮喘疗效。[方法]使用随机平行对照方法,将150例门诊及住院患者按随机数字表法分为两组。对照组75例布地奈德,根据病情选择剂量,2次/d,鼻吸;病情严重可加醋酸泼尼松,5~10mg/次,10~60mg/d,口服。治疗组75例①四子散(白芥子、苏子、莱菔子、吴茱萸各70g),20min/次,2次/d,双肺俞穴位贴敷;②清肺定喘汤(炙麻黄6g,杏仁10g,生石膏先煎50g,黄芩、桑白皮、地龙干、丹参、牡丹皮各15g,白果10g,前胡、百部、车前子布包、莱菔子布包各15g),1剂/d,二煎取汁200mL,早晚口服;西药治疗同对照组。连续治疗14d为1疗程。观测临床症状、中医症候、IgE水平、肺功能、不良反应。治疗1疗程,判定疗效。[结果]治疗组痊愈21例,显效35例,有效17例,无效2例,总有效率97.33%。对照组痊愈10例,显效18例,有效36例,无效11例,总有效率85.33%。治疗组疗效优于对照组(P0.01)。中医症候疗效治疗组优于对照组(P0.01)。IgE水平及肺功能治疗组改善优于对照组(P0.05)。[结论]四子散贴敷加清肺定喘汤联合西药治疗支气管哮喘效果显著,值得推广。     

甲泼尼龙琥珀酸钠、西咪替丁联合定喘汤治疗重症支气管哮喘疗效观察

目的观察甲泼尼龙琥珀酸钠、西咪替丁注射液联合定喘汤治疗重症支气管哮喘的临床疗效。方法将64例重症支气管哮喘患者随机分为观察组和对照组,各32例。两组均采用常规治疗,观察组加用甲泼尼龙琥珀酸钠、西咪替丁注射液及定喘汤。结果观察组有效率96.9%,高于对照组的68.8%(P0.01);观察组消化道症状发生率低于对照组(P0.01)。结论甲泼尼龙琥珀酸钠、西咪替丁联合定喘汤治疗重症支气管哮喘疗效显著,值得临床推广。     

加减定喘汤治疗难治性哮喘的临床研究

目的以难治性哮喘为基础疾病,探讨中医辨证论治联合激素治疗该病的经验。方法选取2010年1月～2012年1月于本院接受治疗的难治性哮喘患者63例进行回顾性研究,其中,中医组20例使用定喘汤加减中医辨证论治,西医组20例给予糖皮质激素、β2受体激动剂及氨茶碱治疗,中西医组23例在西医组基础上加用加减定喘汤治疗。比较3组患者的治疗有效率。结果中医组治疗总有效率明显小于西医组和中西医组,差异有统计学意义（P〈0.05）,西医组总有效率低于中西医组,但差异无统计学意义（P〉0.05）。西医组FVC与FEV1低于中西医组（P〈0.05）;6个月后随访,西医组哮喘发病次数高于中西医组。结论采用加减定喘汤联合糖皮质激素、β2受体兴奋剂治疗难治性哮喘效果明显,适宜临床推广。     

人参核桃汤合定喘汤联合西药治疗慢性肺心病随机平行对照研究

[目的]观察人参核桃汤合定喘汤联合西药治疗慢性肺心病疗效。[方法]使用随机平行对照方法．将65例住院患者按随机数字表法分为两组。对照组32例支气管扩张剂（氨荼碱）,0．1g/次。3次／d,口服;祛痰剂（盐酸氨溴索）．0．6g/次．3次/d,口服。治疗组33例人参核桃汤合定喘汤（太子参、核桃肉、南杏仁、川贝、麦冬、白果肉 去皮 各15g．五味子、麻黄各6g．法夏、苏子 炒 各12g,蛤蚧 去头足打粉冲服 1只）,1剂／d,水煎300mL,早晚口服。心悸加酸枣仁 炒、柏子仁、丹参各12g：胸闷不适加瓜蒌实10g,薤白9g;自汗明显加浮小麦25g,麻黄根10g;腹胀便塘加积壳10g,薏苡仁25g;下肢浮肿,气喘加茯苓皮25g,黄芪、葶苈子 炒 各15g。西药治疗同对照组。连续治疗7d为1疗程。观测临床症状、不良反应。连续治疗4疗程．判定疗效。随访30d．观测复发率。[结果]治疗组显效25例,有效6例,无效2例。总有效率93．94％。对照组显效17例,有效8例．无效7例．总有效率78．13％。治疗组疗效优于对照组（P〈0．01）。[结论]人参核桃汤合定喘汤联合西药治疗慢性肺心病效果显著．值得推广．     

加味定喘汤联合抗痨治疗对重症肺结核患者临床疗效及对患者血气的影响

目的:探讨加味定喘汤联合抗痨治疗对重症肺结核患者临床疗效及对患者血气指标的影响。方法:选取2015年6月至2017年8月上海市浦东新区肺科医院收治的重症肺结核患者136例,按照随机数字表法随机分为对照组和观察组,每组68例。对照组采用抗痨治疗,观察组在对照组的基础上联合加味定喘汤进行治疗,1个月为1个疗程,2组均连续治疗3个疗程。统计2组患者临床疗效;比较2组治疗后病灶吸收情况、痰菌转阴率、病灶空洞闭合情况;检测并比较2组治疗前后血气指标及肺功能水平。结果:治疗后观察组与对照组的总有效率分别为85. 29%、69. 12%,观察组总有效率高于对照组,差异有统计学意义(P 0. 05)。治疗后观察组痰菌转阴率高于对照组,差异有统计学意义(P 0. 05);治疗后观察组病灶空洞闭合的患者比例高于对照组,差异有统计学意义(P 0. 05),病灶空洞增大的患者比例低于对照组,差异有统计学意义(P 0. 05)。与治疗前比较,治疗后2组PaCO_2水平下降,且观察组低于对照组,差异有统计学意义(P 0. 05);与治疗前比较,治疗后2组PaO_2、SpO_2、OI水平及FVC、PEF、FEV_1及MMEF水平显著升高,差异有统计学意义(P0. 05),且观察组均高于对照组,差异有统计学意义(P 0. 05)。结论:加味定喘汤联合抗痨治疗可有效缓解重症肺结核患者临床症状,提升对致病菌的清除率,促进病灶空洞闭合,改善患者血气指标及肺功能,临床疗效突出。     

局部定向抗结核药物缓释材料在兔桡骨内的释放及分布规律

BACKGROUND: Polylactic acid-glycolic acid polymer is a sustained-release material with relatively large drug loading and long-term release abilities that can degrade with cell growth in the body. However, its poor hydrophily easily leads to aseptic inflammation that is detrimental to the body’s recovery. OBJECTIVE: To study the release and distribution of anti-tuberculosis drug delivery materials locally oriented within the rabbit radius. METHODS: After modeling, 20 New Zealand white rabbits with distal radius bone defect were randomly divided into a control group and an experimental group, which were respectively given implantation of isoniazid-rifampicin polylactic acid-glycolic acid polymer/β-tricalcium phosphate material and isoniazid-rifampicin polylactic acid-glycolic acid polymer into the defect. Then, X-ray examination of the defect region was conducted at weeks 4, 8, 12 post implantation. Histological observation and detection of peripheral blood or local blood concentration were performed at week 12. RESULTS AND CONCLUSION: After implantation, Lane-Sandhu X-ray scores were significantly higher in the experimental group than the control group (P < 0.05). The defect in the experimental group was healed completely with less release residual among newborn bone trabeculae and osteocytes were markedly visible on the material surface, while in the control group, new bone tissues were interconnected with the surrounding bone tissues at the defect site, and less release residual was found. Both peripheral blood and local blood concentrations in the experimental group were significantly higher than those in the control group after implantation (P < 0.05). To conclude, the anti-tuberculosis drug delivery material, isoniazid-rifampicin polylactic acid-glycolic acid polymer/β-tricalcium phosphate, has ideal release effect that can stably deliver anti-tuberculosis drugs for a long term at a high bactericidal concentration.       

胰岛素缓释载体材料应用研究与问题

BACKGROUND: Sustained-release carriers of insulin shaped as microspheres made of different biomaterials have become an issue of concern. OBJECTIVE: To summarize the carrier materials and methods to prepare sustained-release microspheres of insulin. METHODS: Wanfang and PubMed databases were retrieved by computer for articles related to sustained-release carriers of insulin published from 1997 to 2015. The search terms were “insulin, controlled-release carrier, biomaterials” in Chinese and English, respectively. RESULTS AND CONCLUSION: Natural biodegradable polymer materials are preferred to prepare sustained-release microspheres of insulin, including gelatin, alginate, chitosan and its derivatives. These natural materials have good biocompatibility, degradability, film-forming and microsphere-forming abilities. Synthetic biodegradable polymer materials as carrier materials can promote drug stability and effective utilization, and realize targeted drug delivery. According to different physicochemical properties of materials, sustained-release carriers of insulin that meet different requirements can be prepared using emulsion-chemical crosslinking, spray drying and solvent evaporation methods. This review provides new insight into the development of stable drug carriers.