HIV/AIDS患者抗病毒治疗病毒学失败中医体质调查*

目的调查病毒学失败的艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人(简称HIV/AIDS患者)的中医体质,分析其体质特征,为艾滋病抗病毒治疗失败者探索新的中医药治疗方案提供一定的理论依据。方法对444例接受抗病毒治疗大于6个月的HIV感染者/AIDS患者进行中医体质调查,根据血浆病毒载量分为病毒学失败组和对照组,对两组患者的体质进行对比分析。结果病毒学失败的HIV感染者/AIDS患者(病毒载量(VL)400 copies/mL)中,五种及以上混合体质所占比例最高(25.3%),其次依次为非平和倾向体质(17.3%)、三种混合体质(13.3%)和两种混合体质(12.0%),非平和单一体质(10.7%)、平和质(10.7%)和四种混合体质所占比例较低(10.7%);对照组(VL≤400 copies/mL)中平和质所占比例最高(25.2%),其次依次为非平和单一体质(19.5%)、非平和倾向体质(17.3%)、两种混合体质(13.3%)、五种及以上混合体质(10.9%)和三种混合体质(9.2%),四种混合体质所占比例最低(4.6%),两组比较差异有统计学意义(P0.01)。病毒学失败的HIV感染者/AIDS患者(VL400 copies/mL)中出现频率较高的偏颇体质是阳虚质(37.1%)和气郁质(24.1%),对照组中出现频率较高的偏颇体质分别为气郁质(33.1%)和气虚质(19.3%),两组比较差异有统计学意义(P0.05)。结论病毒学失败的艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人的体质以五种及以上混合体质为主,出现频率高的偏颇体质为阳虚质和气郁质。     

Recurrent allergic bronchopulmonary aspergillosis in a patient with rheumatoid arthritis treated with etanercept and tocilizumab

Abstract

We report the case of a 68-year-old woman with Stage III and Class II rheumatoid arthritis (RA) that was resistant to prednisolone, methotrexate, and infliximab. After treatment with etanercept or tocilizumab, suspicious allergic bronchopulmonary aspergillosis (ABPA) repeatedly occurred and then rapidly improved after the withdrawal of each drug. We suspect that administration of etanercept and tocilizumab caused suspicious ABPA in this patient. The relevance to the pathogenesis of ABPA under these biological drugs is also discussed.     

Book Review

Abstract

Background:

One of the main health concerns of epoxy resins is their role as skin sensitizer. This sensitization is not uncommon, because the prevalence ranges around 1–12% of the general population.

Objectives:

Perform a cross sectional study in a patch test population from Northeastern Italy to investigate the prevalence of epoxy resins sensitization among patients with suspected contact dermatitis. Subsequently, relate findings to patients’ occupation and evaluate time trend of prevalence.

Methods:

The final study database included 19 088 consecutive patients, tested from 1996 to 2010 in Northeastern Italy.

Results:

The overall prevalence of epoxy resins sensitization was 0·89%. Dermatitis most frequently involved hands (40·25%). In both sexes, we find a significant correlation in mechanics, woodworkers, and chemical industry workers; and in males only, among farmers and fishers, construction workers, and unemployed. We found significant increase of sensitization in construction workers in the analyzed period.

Conclusions:

The overall prevalence of sensitization to epoxy resins in Northeastern Italy is in line with other European countries, but we found an increased risk of sensitization in some professions and an increasing trend of prevalence in construction workers. Better preventive actions are strongly advised in higher risk professions, with particular attentions towards building sector.     

Performance of EAST in diagnosing inhalant allergens in children with allergic rhinitis

The performance of enzyme linked immunosorbent assays (EAST) for identifying six indoor allergens was evaluated using skin prick test (SPT) as reference tests in 154 children with allergic rhinitis. Sensitivity of EAST ranged from 9% (cat) to 54% (HDM) with specificity of 74%(cockroach) to 100% (cat) with an agreement ranged from 58 to 86%. Cut off values ?> ?0.35 kU/L showed best sensitivity and specificity. Our findings agree with extant literature which suggests that the ability of EAST to determine the precipitating allergen is moderate. Assays for definitively identifying the inhalant allergen are currently not available.     

骨科大手术患者中医体质类型与静脉血栓栓塞症相关性研究

目的:探讨骨科大手术患者中医体质类型分布特点及其与静脉血栓栓塞症(VTE)的相关性。方法:选取220例骨科大手术患者,其中术后3个月内并发VTE患者102例为观察组,术后3个月内未发生VTE患者118例为对照组。对两组患者进行中医体质判定并分析。结果:220例骨科大手术患者中,平和质64例(29.09%),偏颇体质156例(70.91%)。骨科大手术患者最常见体质类型为气虚质、血瘀质、平和质。观察组最常见体质类型为气虚质、血瘀质,对照组最常见体质类型为平和质、气虚质。Logistic回归分析发现气虚质、血瘀质与VTE具有显著相关性(P<0.05,P<0.01)。结论:偏颇体质是骨科大手术患者的中医体质类型特征;气虚质、血瘀质是骨科大手术并发VTE患者的危险因素。     

基于针法组合优化研究针刺蝶腭穴结合谢氏“温督祛霾”针法治疗变应性鼻炎的疗效与机制

摘要: 目的 观察针刺蝶腭穴结合谢氏“温督祛霾”针法治疗变应性鼻炎的临床疗效，评估该疗法的有效性、安全性及治疗机制，并形成规范化治疗方案。方法 将120例经中医辨证为虚寒型的变应性鼻炎患者随机分为两组各60例，治疗组选用针刺蝶腭穴结合谢氏“温督祛霾”针法，对照组选用针刺蝶腭穴的方法，4周为1疗程。结果 治疗4 周后治疗组显效率为86.67%,对照组显效率为61.67%，差异有统计学意义；治疗组与对照组在疗程结束及显效以上随访的症状体征积分比较差异有统计学意义；治疗组与对照组疗后实验室指标外周血 EOS、血清IgE对比差异有统计学意义。结论 针刺蝶腭穴结合谢氏“温督祛霾”针法的二者组合，优势互补，优于单一疗法单刺蝶腭穴，且能明显降低患者血清中EOS、IgE计数。     

Non-reflux esophagitis: A review of inflammatory diseases of the esophagus exclusive of reflux esophagitis

Esophagitis is a frequent cause of clinical symptoms and is often an indication for upper endoscopy. Mucosal biopsies are procured for diagnostic purposes and may be used to assess the efficacy of treatment, as in patients with eosinophilic esophagitis. This article outlines salient clinical and pathologic features of diseases that cause esophagitis exclusive of reflux esophagitis.     

高血压与中医体质相关性的荟萃分析＊

目的 通过Meta分析研究高血压与中医体质的相关性，为高血压防治提供依据。方法 通过检索国内文献库，纳入符合要求的高血压与中医体质相关性文献，提取原始文献资料并评价研究的质量；以RevMan 5.3软件进行异质性检验和Meta分析，并通过亚组分析探索异质性来源，以漏斗图评估发表偏倚。结果 共有10篇文献符合纳入标准，涉及高血压病人4 401例，对照组7 934例，全部为横断面研究。痰湿质（OR = 2.24，95%CI：1.77 - 2.83，P < 0.001）、阴虚质（OR = 1.28，95%CI：1.13 - 1.45，P < 0.001）、气虚质（OR = 1.21，95%CI：1.06 - 1.37，P = 0.005）、血瘀质（OR = 1.24，95%CI：1.06 - 1.46，P = 0.007）是高血压人群更易出现的体质类型；而平和质是对照组更易出现的体质类型（OR = 0.56，95%CI：0.51 - 0.61，P < 0.001）；阳虚质、气郁质、湿热质、特禀质在高血压人群和非高血压人群的分布无明显统计学差异。亚组分析显示是否明确纳入既往诊断的高血压和研究质量是异质性主要来源；目测漏斗图未发现明显发表性偏倚。结论 痰湿质、阴虚质、气虚质、血瘀质是高血压易感体质，平和质是保护体质，但由于纳入研究质量不佳，且存在设计缺陷，无法说明中医体质与高血压发生的因果关系，结论需谨慎对待。     

鼻后神经切断术治疗变应性鼻炎

目的通过Meta分析的方法对鼻后神经切断术治疗变应性鼻炎（allergic rhinitis,AR）的有效性与安全性进行分析，以明确该类手术的临床应用价值并提供相关循证学依据。方法通过计算机检索建库至 2019年4月，在Embase、Pubmed、Web of Science数据库、万方数据库、维普中文科技期刊数据库（VIP）及中国期刊全文数据库（CNKI）公开发表的研究鼻后神经切断术治疗AR的临床研究，根据纳入排除标准对文献进行筛选、质量评价和数据提取后，应用Revman 5.3软件对文献原始数据进行Meta分析。结果总共纳入9篇临床研究，包含1 343例患者。Meta分析结果显示，鼻内镜下鼻后神经切断术治疗AR的有效率很高［RD=0.89, 95%CI (0.82, 0.95),P<0.001］，术后鼻通气阻力减小［MD=0.33, 95%CI (0.03，0.62),P=0.03］，鼻塞症状评分降低［MD=3.30, 95%CI (0.60，6.00),P=0.02］，喷嚏症状评分减小［MD=3.21, 95%CI (1.80，4.62)，P<0.001］，流涕症状评分减小［MD=3.33, 95%CI (0.66，6.00)，P=0.01］，并发症发生率很低［RD=0.04, 95%CI (0.01, 0.08), P=0.03］，结果均具有统计学意义。结论鼻后神经切断术治疗AR有效率约为89%，术后鼻通气阻力和鼻塞、打喷嚏、流涕等症状明显减轻，且术后并发症的发生率约为4%，因此该术式对于药物治疗无效的中重度AR患者是一种有效可行的治疗方式。