柴胡桂枝干姜汤联合理中丸加针灸治疗胆汁反流性胃炎的临床效果及对血清炎症因子水平的影响

目的探讨柴胡桂枝干姜汤联合理中丸加针灸治疗胆汁反流性胃炎的临床效果及对血清炎症因子水平的影响。方法筛选我院诊治的胆汁反流性胃炎患者60例,应用数字随机表将其分为对照组与观察组,各30例。对照组给予柴胡桂枝干姜汤加减疗法;观察组运用柴胡桂枝干姜汤联合理中丸加针灸疗法。比较两组的临床疗效及治疗前、后的血清炎症因子(TNF-α和IL-8)水平。结果观察组的临床治疗总有效率高于对照组(P<0.05)。治疗后,两组TNF-α和IL-8水平均降低,且观察组低于对照组(P<0.05)。结论柴胡桂枝干姜汤联合理中丸加针灸治疗胆汁反流性胃炎的疗效确切,可显著改善患者体内的炎症因子水平。     

综合疗法治疗膝关节骨关节炎120例

膝关节骨性关节炎是一种临床常见病，笔者应用综合疗法治疗本病，取得满意疗效，现报道如下。     

The chronic hepatotoxicity assessment of the herbal formula Zishen Yutai pill

Zishen Yutai pill (ZYP) is an oriental herbal formula, while hepatotoxicity assessment of ZYP was rarely evaluated. Therefore, our aim is to re-evaluate its hepatotoxicity in both normal and carbon tetrachloride (CCl₄) induced chronic liver injury rats. In the normal model, two doses of ZYP (1.575 and 9.450 g kg⁻¹ d⁻¹; i.e. 1 × , 6 × clinical doses) were given orally to rats for 24 weeks. In the chronic liver injury model, 10% CCl₄ was administered to rats abdominally twice a week at a dose of 5 mL kg⁻¹ for 12 consecutive weeks. Administration time started from 4 weeks after the beginning of CCl₄ treatment. Toxicological parameters included mortality, body weight, food consumption, clinical signs, biochemical parameters, gross observation, organ weight, necropsy findings and histopathology were monitored. In the normal model, we found no any mortality or abnormality in clinical signs, relative liver weight, biochemical parameters and histopathology in ZYP treatment groups. In the chronic liver injury model, liver damage related parameter such as ALT was elevated at the high dose of ZYP treatment in contrast to the CCl₄-treated group (P < 0.01). In histopathological assessment, there were no significant difference between ZYP treatment groups and CCl₄-treated group. No observed adverse effect on livers were established for 9.450 g kg⁻¹ d⁻¹ ZYP in the normal rats and 9.450 g kg⁻¹ d⁻¹ ZYP in the injury rats.     

宁神补心丸联合“子午流注针法”对脑卒中伴抑郁症患者工作记忆疗效及血清Hcy、NSE的影响

目的 探讨宁神补心丸联合"子午流注针法"对脑卒中伴抑郁症患者工作记忆疗效及血清神经元烯醇化酶（neuron enolase，NSE）、同型半胱氨酸（homocysteine，Hcy）的影响。方法 将2019年1月-2020年1月期间收治的84例急性缺血性脑卒中伴抑郁症患者按照随机数字表随机分为中医治疗组和对照组各42例，所有患者均采取常规内科治疗，对照组给予盐酸帕罗西汀口服抗抑郁治疗，中医治疗组在对照组基础上给予宁神补心丸联合"子午流注针法"治疗，比较2组临床疗效及n-back测试结果，血清Hcy、NSE、碱性髓鞘蛋白（myelin basic protein，MBP）、5-羟色胺（5-hydroxytryptamineand，5-HT）、去甲肾上腺素（norepinephrine，NE）水平及生活质量评分。结果 中医治疗组总有效率92.86%高于对照组76.19%（P<0.05）。治疗后2组HAMD-24评分、NIHSS评分、中医证候积分、血清NSE、Hcy、MBP较该组治疗前明显降低（P<0.05），且中医治疗组下降幅度大于对照组（P<0.05）。治疗后2组n-back测试正确率明显提升，反应时间明显下降（P<0.05），且中医治疗组正确率高于对照组，反应时间低于对照组（P<0.05）；治疗后2组5-HT、NE水平以及生理健康、心理健康、环境领域、社会关系和生存质量得分较本组治疗前明显升高（P<0.05），且中医治疗组高于对照组（P<0.05）。结论 宁神补心丸联合"子午流注针法"治疗脑卒中伴抑郁症能够改善神经功能缺损，缓解抑郁情绪，提高功能记忆功能，猜测其作用机制可能与降低Hcy、NSE水平有关。     

紫外分光光度法测定痛风宁微丸中柚皮苷的含量

目的建立痛风宁微丸中柚皮苷的含量测定方法。方法采用紫外分光光度法测定痛风宁微丸中柚皮苷的含量。以甲醇作空白对照,检测波长415 nm。结果柚皮苷量在0.056~0.196 mg范围内与吸收度呈良好的线性关系,r=0.999 8,平均回收率为99.31%,RSD为0.65%。结论本方法简便可行、结果准确可靠、重复性好,可作为痛风宁微丸柚皮苷的含量测定方法。     

Factors affecting first-month adherence to antiretroviral therapy amongHIV-positive adults in South Africa

This study explores the influence of baseline factors on first-month adherence to highly active antiretroviral therapy (HAART) among adults. The study design involved a review of routinely collected patient information in the CAPRISA AIDS Treatment (CAT) programme, at a rural and an urban clinic in KwaZulu-Natal Province, South Africa. The records of 688 patients enrolled in the CAT programme between June 2004 and September 2006 were analysed. Adherence was calculated from pharmacy records (pill counts) and patients were considered adherent if they had taken at least 95% of their prescribed drugs. Logistic regression was used to analyse the data and account for confounding factors. During the first month of therapy, 79% of the patients were adherent to HAART. HAART adherence was negatively associated with a higher baseline CD4 count. Women had better adherence if they attended voluntarily testing and counselling or if they had taken an HIV test because they were unwell, while men had higher adherence if they were tested due to perceived risk of HIV infection. HAART adherence was positively associated with higher age among patients who possessed cell phones and among patients who provided a source of income in the urban setting, but not in the rural setting. Though long-term data from this cohort is required to fully evaluate the impact of non-adherence in the first month of treatment, this study identifies specific groups of patients at higher risk for whom adherence counselling should be targeted and tailored. For example, first-month HAART adherence can be improved by targeting patients initiated on treatment with a high CD4 count.     

竞争风险模型在2型糖尿病治疗临床试验中的应用

目的探讨竞争风险模型在2型糖尿病治疗临床试验中的应用。方法从北京、上海等地15家三级甲等医院募集未用过任何降糖药物的2型糖尿病患者,将符合入组标准的400例患者按照1∶1的比例随机分为消渴丸组和格列本脲组。患者按照既定方案服药,试验持续48周,每4周随访一次。在达到预先设定最大剂量(消渴丸服用剂量达到30粒/d或格列本脲服用剂量达到3片/d)后连续2次随访空腹血糖均大于7.0mmol/L的患者终止试验。终止试验的患者记为竞争事件。使用竞争风险模型估计两组血糖控制率、使用Gray检验比较两组血糖控制率、使用竞争风险回归模型探索血糖控制率的影响因素。结果共有368例患者纳入分析(两组均有184例)。消渴丸组共有77例患者血糖控制成功,62例患者发生竞争事件。格列本脲组共有78例患者血糖控制成功,61例患者发生竞争事件。消渴丸组血糖控制率为44.76%,其95%置信区间为(37.05%,52.15%);格列本脲组血糖控制率为45.91%,其95%置信区间为(38.00%,53.45%);经Gray检验,两组血糖控制率的差异没有统计学意义(P=0.8105);血糖控制率的影响因素为空腹血糖,相对危险度为0.806。结论在有竞争风险存在的研究中应该使用竞争风险模型;竞争风险模型估计得到的消渴丸组和格列本脲组的血糖控制率差异没有统计学意义。     

冠心苏合丸中桂皮酸的大鼠小肠吸收动力学

目的 研究冠心苏合丸中桂皮酸在大鼠小肠的吸收情况.方法 采用大鼠在体小肠回流实验,采用HPLC法测定小肠循环液中的桂皮酸及酚红,依据药物在小肠内的剩余量来确定药物的吸收.结果 高、中、低浓度的冠心苏合丸肠循环液中,桂皮酸在空回肠的吸收速率常数分别为3.680、3.740、3.795 h-1.结论 冠心苏合丸循环液的浓度对桂皮酸的Ka无影响,桂皮酸在小肠内吸收较好,吸收呈一级动力学过程,吸收机制为被动扩散.     

复方皂矾丸治疗甲状腺功能亢进症并发白细胞减少62例

目的 观察复方皂矾丸治疗甲状腺功能亢进症（甲亢）并发白细胞减少症的临床疗效. 方法 将116例甲亢并白细胞减少症患者随机分为两组,治疗组62例,对照组54例. 治疗组给予复方皂矾丸9粒,po,tid;对照组给予口服利血生20 mg ,tid,维生素B₄ 20 mg ,tid. 两组均2周为1个疗程,共治疗2个疗程. 观察两组治疗后相同时间白细胞恢复情况. 结果 治疗组服用复方皂矾丸的总有效率为83.87%,而对照组总有效率为61.11%,差异有显著性（P＜0.05）. 治疗组白细胞总数升高比对照组显著（P＜0.01）. 治疗组中偶见有轻微胃部不适反应. 结论 复方皂矾丸可作为甲亢并白细胞减少症治疗效果较好的药物,有利于甲亢患者抗甲状腺药物的顺利进行,值得临床推荐使用.     

枳术丸煎剂与枳术汤对大鼠P物质的影响

目的探讨枳术丸与枳术汤对正常大鼠血浆P物质(SP)及肠组织SP的影响。方法正常大鼠分5组,灌胃给药7 d后采集标本,放免检测血浆及肠组织SP含量。结果枳术丸与枳术汤均能升高大鼠血浆SP及肠组织SP含量,呈一定的量-效关系,但枳术丸与枳术汤二者无显著差异。结论升高血及胃肠组织SP含量是枳术丸与枳术汤促进胃肠运动作用的机制之一。