现代旴江医家脾胃学术思想探析

旴江医家人才辈出,薪火相传。现代也涌现出了一批学有专长的学术名家,特别是在传承古代旴江医家脾胃思想的基础上,对脾胃思想有了进一步的发展。结合前辈的思想,将中医理论与临床实践密切联系,对脾胃的思想继承并创新,在国内学术界具有一定的影响。     

食管静脉曲张破裂出血危险因素的超声分析

目的 探讨食管静脉曲张(EV)破裂出血的独立危险因素.方法 69例乙肝肝硬化患者分为出血组(31例)和非出血组(38例),采用超声测量门静脉内径和血流速度、脾静脉内径(Dsv)和血流速度、脾厚径和脾长径、胃左静脉内径(DLGv)和血流方向.将是否发生EV出血作为因变量,上述超声参数作为自变量,用Logistic回归分析筛选出EV出血的独立危险因素,用卡方检验比较两组DLGv＞5.95 mm和Dsv＞10.55 mm的发生率.结果 Logistic回归分析显示,DLGv和Dsv是EV出血的独立危险因素优势比(OR)=0.458,P＜0.01、OR=1.425(P＜0.05).出血组DLGv＞5.95 mm者占83.9％,高于非出血组28.9％(P＜0.01);出血组Dsv＞10.55 mm者占74.2％,高于非出血组的28.9％(P＜0.01).结论 DLGv和Dsv是EV出血的独立危险因素.     

Splenic extrafollicular reactions and BM plasma cells sustain IgM response associated with hypercholesterolemia

Hypercholesterolemia associated with atherosclerotic disease is known to be associated with increased total and oxidized (ox) low‐density lipoprotein (LDL)‐specific IgM antibodies in circulation. However, the B‐cell responses accounting for this increase remain to be elucidated. Here, we observed an association between total IgM and oxLDL‐specific IgM autoantibodies with cholesterol in the plasma of hypercholesterolemic apolipoprotein E deficient (apoE^?/?) mice. Our findings also indicated that oxLDL‐specific IgM autoantibodies production was restricted to the spleen, but not the lymph nodes. Further examination of the spleen revealed that the extrafollicular responses, but not germinal center reactions, were the dominant antibody‐producing pathway. A quiescent population of IgM⁺ plasma cells including oxLDL‐specific IgM antibody secreting cells in BM also sustained the elevated IgM antibodies response in circulation. We determined that IgM⁺ plasma cells in the BM were, at least in part, splenic derived by depleting CD11c⁺ DCs and plasmablasts to disrupt the humoral responses. In addition, lowering hypercholesterolemia reduced IgM response by interfering with extrafollicular and BM responses. By elucidating the mechanism underlying the elevated IgM response observed in hypercholesterolemia, this study provides insight into novel immunotherapeutic avenues.     

Foxp3+ regulatory T‐cell homeostasis quantitatively differs in murine peripheral lymph nodes and spleen

Regulatory T (Treg) cells are essential for maintaining self‐tolerance and modulating inflammatory immune responses. Treg cells either develop within the thymus or are converted from CD4⁺ naive T (Tnaive) cells in the periphery. The Treg‐cell population size is tightly controlled and Treg‐cell development and homeostasis have been intensively studied; however, quantitative information about mechanisms of peripheral Treg‐cell homeostasis is lacking. Here we developed the first mathematical model of peripheral Treg‐cell homeostasis, incorporating secondary lymphoid organs as separate entities and encompassing factors determining the size of the Treg‐cell population, namely thymic output, homeostatic proliferation, peripheral conversion, transorgan migration, apoptosis, and the Tnaive‐cell population. Quantitative data were collected by monitoring Tnaive‐cell homeostasis and Treg‐cell rebound after selective in vivo depletion of Treg cells. Our model predicted the previously unanticipated possibility that Treg cells regulate migration of Tnaive cells between spleen and peripheral lymph nodes (LNs), whereas migration of Treg cells between these organs can largely be neglected. Furthermore, our simulations suggested that peripheral conversion significantly contributed to the maintenance of the Treg‐cell population, especially in LNs. Hence, we provide the first estimation of the peripheral Treg‐cell conversion rate and propose additional facets of Treg‐cell‐mediated immune regulation that may previously have escaped attention.     

声触诊组织量化技术评估经颈静脉肝内门体分流术联合胃冠状静脉栓塞术疗效

目的 探讨应用声触诊组织量化(VTQ)技术测量脾脏剪切波速度(SSWV)无创评价经颈静脉肝内门体分流术(TIPS)联合胃冠状静脉栓塞术(GCVE)疗效的价值。方法 将19例接受TIPS联合GCVE治疗的肝硬化门静脉高压患者分为A(13例,接受1次治疗)、B(6例,首次治疗后因支架闭塞再次接受治疗)两组。应用VTQ技术分别与治疗前1天、治疗后6天测量SSWV,以脉冲波多普勒测量门静脉主干血流速度(PVV)、脾静脉主干血流速度(SVV)。于TIPS联合GCVE治疗过程中,以直接测压法测量支架植入前及植入后的门静脉压(PPG),并进行统计分析。结果 TIPS联合GCVE治疗后,A、B两组PPG均较治疗前明显减低(P均<0.05);SSWV均较治疗前明显减低,PVV、SVV均较治疗前明显升高(P均<0.05)。A、B两组治疗前及治疗后SSWV均与PPG呈正相关(P均<0.05),PVV、SVV均与PPG无相关性(P均>0.05)。结论 应用VTQ技术所测SSWV与PPG存在相关性,可作为TIPS联合GCVE治疗前后监测门静脉压力的无创定量评估指标。     

Ambulatory abdominal inductance plethysmography: towards objective assessment of abdominal distension in irritable bowel syndrome

BACKGROUND: Abdominal distension is one of the cardinal features of irritable bowel syndrome (IBS) with patients often ranking it as more intrusive than their pain or bowel dysfunction. If this symptom could be quantified accurately and reliably it would provide, for the first time, an objective way of assessing this disorder. Using the principle of inductance plethysmography we have developed a microprocessor based system capable of recording even minimal changes in girth over 24 hours and we describe its validation and establish normal ranges. METHODS: Twenty four hour recordings were made in 20 healthy female volunteers (aged 23-58 years) to assess changes in abdominal girth with respect to time, posture, meals, and sleep. Normal daily activity was encouraged and meals were standardised. The feeling of abdominal distension was also assessed using a visual analogue scale. FINDINGS: Measurement of abdominal girth using abdominal inductance plethysmography (AIP) at a static point in time showed a close relationship with that measured using a tape measure (rho=0.8910, p<0.001). Furthermore, girth was significantly greater both in the sitting and standing postures compared with lying (p<0.01). Measurement over a 24 hour period showed that girth was significantly greater at the end compared with the beginning of the day, and ingestion of a standard meal also increased its value (p<0.05). Sleep was associated with a reduction in girth (p<0.05). CONCLUSIONS: AIP promises to add an objective dimension to the assessment of IBS which could prove invaluable in clinical trials. Furthermore, it should aid research into the pathogenesis of this symptom for which no satisfactory explanation has yet emerged.     

李东垣从脾胃论治五脏病遣方用药规律及其临床意义

金元医家李东垣根据《素问·六节藏象论》中“至而不至,此谓不及,则所胜妄行,而所生受病,所不胜薄之也”的理论,在其所著《脾胃论》中提出了“心之脾胃病”“肺之脾胃病”“肝之脾胃病”“肾之脾胃病”等五脏病的症状特点及其因机证治,通过分析李东垣治疗上述五脏病的遣方用药规律,深入探讨脾胃与其余四脏生理病理的相关性及其临床意义.     

心脑宁胶囊治疗血脂代谢异常的临床疗效及安全性观察

目的：观察心脑宁胶囊治疗血脂代谢异常的临床疗效及安全性。方法将86例血脂代谢异常的患者随机分为治疗组（44例）和对照组（42例）。两组均予相同的基础治疗,对照组加用辛伐他汀（40 mg,晚间服）,治疗组加用心脑宁胶囊（每次3粒,每日3次）,1个疗程均为12周,观察记录治疗前后血脂指标及症状积分的变化。结果治疗组总有效率为88.6%,显著高于对照组（69.0%,掊2=6.58,P<0.01）。治疗后治疗组TC、TG、LDL-C的降低程度显著优于对照组,HDL-C升高程度显著优于对照组,差异均有统计学意义（P<0.05）。治疗组症状积分改善情况优于对照组（掊2=9.89,P<0.01）。治疗组未出现毒副反应。结论心脑宁胶囊改善血脂代谢指标疗效显著、安全可靠,且能更好地减轻临床症状。