银屑病与肥胖相关性的研究进展

【摘要】 目前普遍认为，银屑病与肥胖之间存在相关性，但确切机制尚未明确。研究认为，共同的炎症通路和胰岛素抵抗等因素可能是二者相关联的共同病因机制之一，了解肥胖对银屑病发病及治疗等方面的影响，将有助于银屑病的治疗。     

重叠综合征并发横纹肌溶解症一例

74岁女性患者,手足及口周部位皮肤变硬2个月余,伴乏力、酱油色尿1个月。血清肌酸激酶4 242 U/L,肌红蛋白1 124 ng/ml。诊断为重叠综合征并发横纹肌溶解症。经甲泼尼龙80 mg每日1次、甲氨蝶呤15 mg每周1次治疗,效果不理想,转入肾病内科行血液净化治疗。血清肌红蛋白恢复正常后,继续口服甲泼尼龙40 mg每日1次,定期复诊并缓慢减量。目前甲泼尼龙减量至16 mg/d,己持续治疗1年,血清肌酸激酶及肌红蛋白均在正常范围。     

红光与常规治疗对成人急性化脓性中耳炎的协调作用

目的观察在常规治疗基础上联合红光照射对成人急性化脓性中耳炎(acute suppurative otitis media,ASOM)临床疗效的影响。方法确诊为急性化脓性中耳炎的患者62例68耳,随机分为对照组31例33耳,使用抗生素滴耳、口服黏液促排剂;试验组31例35耳,在此基础上联合红光照射治疗。治疗后7和14 d比较两组患者临床症状改善情况、听力恢复情况;记录外周血的TNF-α、IL-2、IL-6、IL-10、IL-1β;以及耳道内致病菌株数。结果治疗后7和14 d,试验组临床症状改善情况和听力恢复情况(气导听阈均值、气-骨导听阈差均值)分别优于相同治疗时间点的对照组(P<0.05);治疗第7天,对照组外周血的TNF-α和IL-6较治疗前有显著下降(P<0.05),试验组外周血的TNF-α、IL-2、IL-6、IL-10、IL-1β均较治疗前有显著下降(P<0.05)。试验组与对照组相比,除IL-10外,其余炎性因子下降幅度均低于对照组(P<0.05);治疗第14天,两组耳道内致病菌株数显著降低(P<0.05),且试验组显著低于对照组(P<0.05)。结论对于ASOM患者,在常规抗生素联合黏液促排剂治疗的基础上联合红光治疗,可加速鼓室黏膜恢复正常、提高听力改善速度和程度,其机制可能与红光协同消除病原菌、加速降低多项炎性因子水平有关。联合红光治疗对于抗生素疗效不佳而导致病情恢复较慢的患者是很好的选择。     

Comprendre les troubles du sommeil de patients adultes atteints d’une maladie de Crohn pris en charge en ambulatoire

ObjectivesResearch has shown that sleep disturbances can negatively influence the progression of chronic inflammatory diseases, including chronic inflammatory bowel disease (IBD). More specifically, poor sleep quality is strongly related to the clinical activity of the disease. Nevertheless, some patients suffer from sleep disorders even when the disease is clinically inactive. Psychological factors, such as depression and anxiety, are also known to contribute to poor sleep quality. Depression and anxiety are common in chronic diseases. In addition, while the link between depression or anxiety and sleep disorders is well-known, the link between sleep disorders and inflammation has only been studied recently. Sleep studies in IBD patients have generally excluded patients with clinically diagnosed depression or anxiety in order to neutralize their effects on the relationship between inflammation and sleep disorders. Nevertheless, there is no consensus on the relationship between depression and anxiety and the clinical activity of the disease. When a patient with chronic inflammatory bowel disease (Crohn's disease here) complains of fatigue or poor sleep, the subjective aspects of these complaints therefore lead the clinician to consider them simply as: a characteristic of IBD, exhaustion related to the chronicity of the disease, unsatisfactory sleep quality, a manifestation of a depressive mood, or a consequence of an anxious state. When a patient reports a subjective complaint of poor sleep or fatigue in a complex, multi-determined clinical situation, it can thus be difficult to identify its most likely cause and to establish the best possible therapeutic intervention.Patients, materials and methodsThe aim of this work was to determine which element (disease activity, inflammation, depression, anxiety) is most closely related to sleep disorders in patients with Crohn's disease (CD) referred for outpatient psychological assessment. Ninety-seven patients with CD participated in this study. Their mean age was 34.70 (± 10.85) years. They were asked about their sleep (IQSP, ISI, ESD) and mood (HADS). They also provided details of clinical disease activity (Harvey–Bradshaw Index) and inflammation (CRP). In order to determine the nature and extent of the relationship between the variables, Spearman correlation coefficients were calculated, supplemented by multiple regression analyses to determine the variables that could explain the sleep disorders.ResultsThe results show that sleep quality (IQSP) was significantly predicted by the Harvey–Bradshaw score (β = 0.21; β standardized = 0.24; t = 2.6; P = 0.01) and depression (β = 0.45; β standardized = 0.41; t = 4.55; P < 0.001). The Harvey–Bradshaw score (β = 26; β standardized = 2; t = 2.27; P = 0.026) and depression score (β = 75; β standardized = 47; t = 5.34; P < 0.001) were related to the insomnia score (ISI). Finally, daytime sleepiness (DSA) was predicted by the depression score (β = 42; β standardized = 432; t = 3.17; P = 0.002) and by the CRP (β = − 0.05; β standardized = − 0.21; t = − 2.13; P = 0.036). The results show that the severity of clinical activity of the disease was associated with poor sleep quality and insomnia. However, there was a stronger association between the intensity of depression and sleep disturbances than between these variables and clinical disease activity. It therefore seems important that sleep disorders and their management should be considered first from the perspective of depression. However, it is important that CD is not assumed to be the sole cause of depression: other factors (dispositional or situational) should also be taken into consideration. Nevertheless, while our results show a weaker link between inflammation and sleep disorders than other studies, they confirm the link between sleep disorders and disease activity.ConclusionsIn order to predict the likelihood and nature of relapses, it seems important that future research should take into account not only disease activity and inflammation, but also disorders of arousal and nocturnal awakenings experienced by the patient.     

Endoscopic and histologic activity assessment considering disease extent and prediction of treatment failure in ulcerative colitis

Abstract

Background and Aims

DUBLIN score allows evaluation of disease activity and extent in ulcerative colitis (UC). This study aimed to evaluate DUBLIN score as a predictor of therapeutic failure as well as to associate endoscopic and histological activity scores to assess their joint performance.     

化毒清湿汤对复杂性肛瘘新型探查术后患者手术创面恢复功效研究

目的:研究化毒清湿汤对于复杂性高位肛瘘新型探查术后患者手术创面恢复及相关细胞因子水平的改善功效。方法: 从接受复杂性肛瘘新型探查术治疗的患者中选取104例纳入本次研究,入选患者随机均分为对照组与治疗组,对照组给予术后常规治疗,治疗组在对照组疗法的同时加用化毒清湿汤治疗,于术后2 d、15 d分别对比两组患者的创面面积、疼痛程度,观察创面愈合时间; 术后28 d评估两组疗效,同时观察两组患者术后2 d、28 d时血清细胞生长因子与炎性因子水平的变化。结果:治疗组总有效率98.08%高于对照组的86.54%(P<0.05); 术后15 d两组创面面积、疼痛VAS评分均有所降低且两组比较治疗组更低; 治疗组创面愈合时间为(23.71±5.57)d,对照组为(30.46±7.92)d,两组比较治疗组更低(P<0.05); 术后28 d两组各项细胞生长因子均有上升,组间比较治疗组更高,差异具有统计学意义(P<0.05); 术后28 d两组各项炎性因子均有好转,组间比较治疗组更优,差异具有统计学意义(P<0.05)。结论:化毒清湿汤可提高复杂性肛瘘新型探查术临床疗效,加快患者术后后创口愈合速度,进一步改善患者细胞生长因子与炎性因子的表达水平。     

益气化瘀盆炎汤加减治疗盆腔炎气虚血瘀证疗效及对患者血液微循环的影响

目的:探讨益气化瘀盆炎汤加减治疗盆腔炎气虚血瘀证临床疗效及对患者血液微循环的影响。方法:将96例盆腔炎气虚血瘀证患者,随机分为对照组与观察组,各48例。对照组给予左氧氟沙星联合桂枝茯苓胶囊治疗,观察组在对照组治疗基础上给予益气化瘀盆炎汤加减治疗,连续用药2个疗程。比较两组患者临床疗效、治疗前后的中医症候积分、炎性包块直径、盆腔积液深度、血液微循环指标、炎症因子水平、补体C₃和C₄水平,及用药期间的不良反应发生情况。结果:观察组临床治愈率较对照组更高,组间比较差异均有统计学意义(P<0.05)。观察组治疗后的中医症候积分、炎性包块直径、盆腔积液深度均较对照组下降更显著,观察组治疗后的血清ICAM-1、D-二聚体、血浆黏度、红细胞沉降率、血小板聚集率水平均较对照组下降显著,IL-2、IL-10、MMP-2水平均较对照组明显提高,组间比较差异均有统计学意义(P<0.05)。观察组治疗后的补体C₃和C₄水平均较对照组高,组间比较差异具有统计学意义(P<0.05)。两组用药过程中均未见肝肾功能损伤等严重不良反应发生。结论:益气化瘀盆炎汤加减治疗盆腔炎气虚血瘀证疗效较好,其机制可能与改善患者血液微循环、免疫功能及控制炎症因子水平有关。     

肾炎方联合缬沙坦分散片对慢性肾小球肾炎患者的疗效与肾功能的影响

目的:探究肾炎方联合缬沙坦分散片治疗慢性肾小球肾炎患者的疗效及对肾功能的影响。方法:选取2016年2月至2019年2月重庆医科大学附属一医院合川医院肾脏内科收治的慢性肾小球肾炎患者122例作为研究对象,随机分为对照组和观察组,每组61例。对照组患者采用下缬沙坦分散片治疗,观察组在对照组基础上采用自拟肾炎方与缬沙坦分散片联合治疗,分析比较2组患者的肾功能指标的动态变化、炎性因子的表达水平、临床疗效及治疗后不良反应。结果:治疗后观察组TC、TG、BUN、Scr及24 hUPE5项指标的动态变化均低于对照组,差异有统计学意义(P<0.05),且观察组ALB动态变化高于对照组,差异有统计学意义(P<0.05);治疗后观察组IL-6、IL-10、CRP及TNF-α水平明显低于对照组,差异有统计学意义(P<0.05),观察组治疗有效率(98.4%)优于对照组(86.9%),差异有统计学意义(P<0.05);观察组不良反应发生率(6.6%)低于对照组(31.1%),差异有统计学意义(P<0.05)。结论:采用自拟肾炎方与缬沙坦分散片联合的治疗方案可增强疗效,提升肾功能,降低促炎性因子的表达水平及不良反应,值得在临床中推广普及。     

冠心宁片联合西药治疗冠心病稳定型心绞痛临床研究

目的:观察冠心宁片联合西药治疗冠心病稳定型心绞痛的效果及对血脂水平和炎症反应的影响。方法:选取冠心病稳定型心绞痛患者150例,采用随机数表法分为观察组和对照组各75例。对照组给予西医常规治疗,观察组在对照组的基础上联合冠心宁片治疗,2组均以4周为1个疗程,连续治疗3个疗程。比较2组患者血清总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、超敏C-反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)、单核细胞趋化因子-1(MCP-1)、心绞痛症状评分、中医证候评分及临床疗效。结果:经过治疗,观察组血清TG、TC、LDL-C、hs-CRP、TNF-α、MCP-1水平低于对照组,HDL-C水平高于对照组,差异均有统计学意义(P<0.05)。心绞痛评分及中医证候评分低于对照组,差异有统计学意义(P<0.05)。观察组总有效率为88.00%,高于对照组的73.33%,差异有统计学意义(P<0.05)。结论:使用冠心宁片联合西药治疗冠心病稳定型心绞痛患者,能够显著调节患者血脂水平,抑制炎症反应,改善临床症状,值得推广。