应用匹配矩阵、因子分析和聚类分析法研究冠心病痰瘀证候特征

目的研究冠心病痰瘀证候与临床四诊信息的相互关系,为其分类及规范化诊断提供参考。方法采用匹配矩阵、因子分析和聚类分析法,对200例冠心病患者痰证、瘀证、痰瘀互阻证及非痰非瘀证46项临床症状进行相关性分析。结果冠心病不同痰瘀证候舌、脉象与非痰非瘀证之间存在明显差异;中医病机脏腑定位于心和肾,以心气虚为主,兼肾气虚,痰证患者尚多伴脾气虚;在46项临床症状中,仅15项症状在痰证、瘀证和痰瘀互阻证中相伴出现频率较高。除共有的本虚证外,痰证的主要临床症状为白腻苔和滑脉,尚见胸脘痞满和腹胀等;瘀证则以紫舌、舌生瘀斑为主,尚见痛有定处;痰瘀互阻证则兼上述两种证候的主要症状。结论综合应用匹配矩阵、因子分析和聚类分析法,可以获得有关冠心病不同痰瘀证候主要临床特征及脏腑定位的信息,对冠心病不同痰瘀证候辨证及其分类研究具有一定的意义。     

血瘀证病证结合研究现状与思考

血瘀证存在于临床各科疾病的发展过程之中。在既往的研究和临床工作中,已经发现不同疾病血瘀证的临床表现和客观指标变化存在一定的差异性。同证在不同疾病之间的相似性及差异性是中医辨证论治的依据,研究不同疾病中血瘀证的共性,能够体现中医辨病与辨证相结合的特色,有可能进一步揭示血瘀证和中医药现代化之间更深层次的联系。目前对血瘀证病证结合的研究尚未有系统的总结报道。本文从冠心病、糖尿病、心脑血管疾病入手,将近年来血瘀证病证结合研究的进展综述如下。1冠心病临床上多从血脂和血液流变学异常的角度来研究冠心病和血瘀证的关系…     

绝经后骨质疏松症患者骨密度及性激素水平与肾虚证的关系

为探讨女性绝经后骨质疏松症(postmenopausal osteoporosis PMO)患者骨密度(bone mineral density BMD)和性激素水平的变化与不同肾虚证型之间的内在联系,为临床辨证论治提供客观诊断依据.选择88例肾虚证PMO患者为研究对象,其中肾气虚组37例,肾阴虚组29例,肾阳虚组22例,另设对照组30例,同步检测骨密度、血清睾酮(T)和雌二醇(E2),计算E2/T并进行统计学分析.结果PMO患者骨密度随肾气虚、肾阴虚、肾阳虚依次下降,其中肾阳虚组较对照组和肾气虚组显著下降(P＜0.01);PMO不同肾虚证型组骨密度变化均为Ward＞Neck＞Troch.与对照组比较,不同肾虚证型组T显著升高(P＜0.01),性激素T水平的变化按肾气虚、肾阴虚、肾阳虚逐渐升高,而E2、E2/T则逐渐降低;不同肾虚证型组E2、E2/T较对照组显著下降(P＜0.01).表明①PMO患者骨密度随肾气虚、肾阴虚、肾阳虚依次下降,不同肾虚证型组骨密度变化均为Troch＞Neck＞Ward;②PMO患者性激素T水平的变化按肾气虚、肾阴虚、肾阳虚逐渐升高,而E2、E2/T则逐渐降低;③骨密度和性激素水平反应了肾虚程度,即依肾气虚-肾阴虚-肾阳虚逐渐加重.④骨密度测定值和性激素水平的变化可作为PMO不同肾虚证型的客观评价指标,并为PMO患者不同肾虚证型的治疗效果的观察提供参考依据.     

肝癌患者中医辨证分型与肝癌细胞体外化疗药物敏感性的关系

目的:观察不同中医辨证分型肝癌患者肝癌细胞体外化疗药物敏感性.方法:选取60例肝癌切除标本,利用MTT法测定不同证型肝癌患者对6种常用化疗药物的体外敏感性.结果:脾气虚组、肝气郁结组、瘀血阻络组之间各药敏感性有逐步下降趋势,但无统计学意义;各药在肝瘀脾虚阻络组敏感性明显下降.结论:不同中医辨证分型肝癌患者对化疗药物的敏感性存在一定差异,中西医结合个体化治疗肝癌,就是要根据具体患者药敏实验结果结合辨证论治设计治疗方案.     

糖尿病患者周围神经电生理改变与中医证型的关系探讨

目的探讨2型糖尿病患者周围神经电生理改变与中医证型之间的关系.方法将1 28例DM患者辨证分型为:气阴两虚、脾虚痰湿、阴阳两虚、阴虚燥热、湿热痹阻、气滞血瘀.并检测肌电图、运动神经传导速度(MCV)以及运动传导潜伏期(ML)等.结果 128例EMG异常肌肉382块(77.0%),其中气阴两虚型57例159块;脾虚痰湿型26例81块;阴阳两虚型1 4例38块;阴虚燥热型13例37块;湿热痹阻型10例36块;气滞血瘀型8例31块.MCV异常者823条(83.6%).其中阴虚燥热型MCV正常者最多,四种神经发生MCV异常的比率较其他证型明显减低(P＜0.01),以气滞血瘀型MCV异常率最高,其次为湿热痹阻型.在6种不同证型中,以气滞血瘀型的ML最长,湿热痹阻型其次,气阴两虚型最短.结论2型糖尿病患者周围神经电生理改变,以气滞血瘀型最为显著,其次为脾虚痰湿型和湿热闭阻型,说明实证较虚证发生周围神经病变的机会增加,病情相对较重.     

Relation of Blood Arsenic Concentration with Effect and Safety of Arsenic-Containing Qinghuang Powder (青黄散) in Patients with Myelodysplastic Syndrome

Objective: To investigate the relation of blood arsenic concentration(BAC) with clinical effect and safety of arsenic-containing Qinghuang Powder(青黄散, QHP) in patients with myelodysplastic syndrome(MDS). Methods: Totally 163 patients with MDS were orally treated with QHP for 2 courses of treatment, 3 months as 1 course. The BACs of patients were detected by atomic fluorescence spectrophotometry at 1, 3, and 6 months during the treatment, and the effective rate, hematological improvement and safety in patients after treatment with QHP were analyzed. Results: After 2 courses of treatment, the total effective rate was 89.6%(146/163), with 31.3%(51/163) of hematological improvement and 58.3%(95/163) of stable disease. The hemoglobin increased from 73.48±19.30 g/L to 80.39±26.56 g/L(P0.05), the absolute neutrophil count increased from 0.81±0.48×10~9/L to 1.08±0.62×10~9/L(P0.05), and no significant changes were observed in platelet counts(P0.05). Among 46 patients previously depended on blood transfusion, 28.3%(13/46) completely got rid of blood transfusion and 21.7%(10/46) reduced the volume of blood transfusion by more than 50% after treatment. The BACs were significantly increased in patients treated for 1 month with 32.17±18.04 μg/L(P0.05), 3 months with 33.56±15.28 μg/L(P0.05), and 6 months with 36.78±11.92 μg/L(P0.05), respectively, as compared with those before treatment(4.08±2.11 μg/L). There were no significant differences of BACs among the patients treated for 1, 3 and 6 months(P0.05). The adverse reactions of digestive tract during the treatment were mild abdominal pain and diarrhea in 14 cases(8.6%), and no patients discontinued the treatment. The BACs of patients with gastrointestinal adverse reactions were significantly lower than those without gastrointestinal adverse reactions(22.39±10.38 vs. 37.89±11.84, μg/L, P0.05). The BACs of patients with clinical effect were significantly higher than those failed to treatment(40.41±11.69 vs. 23.84±12.03, μg/L, P0.05). Conclusion: QHP was effective and safe in the treatment of patients with MDS and the effect was associated with BACs of patients.     

It is time to shift the treatment paradigm in myelodysplastic syndromes: A focus on novel developments and current investigational approaches exploring combinatorial therapy in high-risk MDS

Higher risk myelodysplastic syndromes are defined as a subset of disease with higher risk of AML transformation and poor overall survival. For decades, therapeutic options for high-risk MDS have been limited to allogeneic stem cell transplant (the only option for cure but limited to only a handful of patients) or hypomethylating agents, with the goal to alter the natural history of disease, delay progression and improve survival, while addressing cytopenias, transfusion requirements and improving quality of life. Recent developments in DNA sequencing and other technologies have shed significant light into the pathogenesis of MDS and led to rational and targeted drug development across a variety of therapeutic vulnerabilities, including disruption of protein ubiquitination through NAE inhibition, selective modulation of macrophage activity and immune checkpoint inhibition through blockade of TIM-3. This review highlights some of the most promising agents in recent drug development and their therapeutic efficacy in the management of high-risk MDS, and further explores the rationale behind potential combinatorial approaches using an HMA backbone to synergistically improve treatment outcomes.     

Response to pretransplant hypomethylating agents influences the outcome of allogeneic hematopoietic stem cell transplantation in adults with myelodysplastic syndromes

This study describes a retrospective analysis on the transplant outcome of 56 consecutive patients with myelodysplastic syndrome (MDS) according to their response to hypomethylating agents (HMA). While 2‐yr disease‐free survival (DFS) of patients who transformed to acute myeloid leukemia (n = 12) was 25%, that of the remaining patients with MDS according to response to HMA was 73.1%, 68.1%, 50.0%, and 20.8% in G‐COR (group of continuous response, n = 19), G‐NoC (group of no change, n = 15), G‐LOR (group of loss of response, n = 6), and G‐DP (group of disease progression, n = 4), respectively. When dichotomized as G‐COR/G‐NoC versus G‐LOR/G‐DP, significantly different 2‐yr DFS (71.0% vs. 33.3%; P = 0.004) and relapse (14.1% vs. 46.7%; P = 0.016) were demonstrated. On multivariate analysis, G‐LOR/G‐DP [hazard ratio (HR), 3.91; P = 0.008] and poor karyotype at transplantation (HR, 2.69; P = 0.017) were the significant predictors for poor DFS, as G‐LOR/G‐DP was for relapse (HR, 6.28; P = 0.011). DFS was significantly poor in patients with any of the two predictors in all MDS (81.5% vs. 34.9%; P = 0.001) or higher‐risk MDS (HrMDS) at the time of HMA (80.7% vs. 29.2%; P = 0.005). G‐COR showed a trend of better DFS compared with G‐NoC among HrMDS (74.6% vs. 36.5%; P = 0.090). These results implicate the significance of response to HMA on hematopoietic stem cell transplantation (HSCT) outcomes and support the need for future study to verify the suggested strategy of proceeding to transplantation before LOR or DP, especially for HrMDS.     

Compartment syndrome and rhabdomyolysis as a positioning complication following retrosigmoid craniotomy

The goal of surgical positioning is to provide optimal surgical access and visualization while maintaining the patient's safety, with the least physiological compromise. Here, we report a 30-year-old man with an unremarkable past medical history who developed superior vena cava syndrome after a 15-hour retrosigmoid craniotomy for removal of a right cerebellopontine (CP) angle tumor. Compartment syndrome from the head to neck and rhabdomyolysis were recognized, with extensive swelling of his head and neck, markedly swollen soft tissues and necrosis of multiple muscles revealed by computed tomography, and very high concentrations of creatine kinase (CK) and aspartate transaminase. Immediate intensive care and rehabilitation therapy were provided and aimed at maintaining adequate perfusion/oxygenation and decreasing tissue pressure. He was successfully weaned from ventilation on postoperative day (POD) 25, transferred to a general ward on POD 29, and discharged with mild muscular and neurological sequelae on POD 51. Careful adjustment of surgical positioning is crucial for patient safety, especially when positioned at an extreme position in association with prolonged surgery.     

骨髓增生异常综合征最低诊断标准 （2017） 解读

骨髓增生异常综合征 （MDS） 是一组异质性髓系克隆性疾病， 特征是外周血细胞减少、 发育异常、 大约30% 向急性髓系白血病 （AML） 转化。在过去的15年中， MDS诊断、 预后和治疗大幅改善。然而， 随着分子标志和靶向治疗的出现， MDS面临新的挑战。本文对MDS最低诊断标准的更新及MDS前期疾病进行总结。