补肾壮筋汤联合针刺治疗肝肾亏虚型腰椎间盘突出症疗效观察及对单核细胞NLRP3表达的影响

目的:观察补肾壮筋汤联合针刺治疗肝肾亏虚型腰椎间盘突出症的临床疗效及其对外周血单核细胞核苷酸结合寡聚化结构域样受体蛋白3 (NLRP3)炎症小体表达的影响。方法:将96例患者随机分为对照组和观察组,对照组48例采用常规牵引治疗,观察组48例在对照组的基础上加用补肾壮筋汤联合针刺治疗;观察比较2组患者临床疗效、NLRP3炎症小体表达、白细胞介素-1β(IL-1β)及白细胞介素-6 (IL-6)、日本骨科协会评估治疗评分(JOA)及不良反应情况。结果:总有效率观察组为95.83%,对照组为77.08%,2组比较,差异有统计学意义(P0.05)。治疗后,2组患者凋亡相关斑点蛋白(ASC) mRNA水平较治疗前低(P0.05),半胱氨酸天冬氨酸蛋白酶1 (Caspase-1) mRNA、NLRP3 mRNA水平较治疗升高(P0.05);且观察组上述指标改善均较对照组更明显(P0.05)。治疗后,2组患者IL-1β、IL-6水平均较治疗前降低(P0.05),且观察组IL-1β、IL-6水平低于对照组(P0.05)。2组患者JOA评分均较治疗前明显升高(P0.05),且观察组JOA评分高于对照组(P0.05)。观察组患者针刺部位出现血肿2例,局部剧烈刺痛感1例,经对症治疗后好转。结论:补肾壮筋汤联合针刺治疗肝肾亏虚型腰椎间盘突出症疗效显著,可有效抑制机体炎症反应,从而改善患者临床症状。     

枇杷叶紫珠化学成分及其细胞毒活性和抗炎活性

目的研究枇杷叶紫珠Callicarpa kochiana的化学成分及其细胞毒活性和抗炎活性。方法枇杷叶紫珠90%丙酮提取物采用硅胶、Sephadex LH-20、MCI、ODS、重结晶、半制备HPLC进行分离纯化,根据理化性质及波谱数据鉴定所得化合物的结构。采用CCK8法、Griess法、ELISA法测定化合物4~5的细胞毒活性和抗炎活性。结果从中分离得到5个化合物,分别鉴定为3,7,3’,4’-tetramethyl-quercetin (1)、pachypodol (2)、14α-hydroxyisopimaric acid(3)、14α-hydroxy-7,15-isopimaradien-18-oic acid (4)、(16R)-16,17-dihydroxyphyllolladan-3-one (5)。化合物4在一定浓度范围内对7种肿瘤细胞具有不同程度的抑制作用,并可以减少RAW264. 7细胞NO、IL-10、MCP-1、TNF-α的释放量。结论化合物1~5均为首次从该植物中分离得到,化合物4具有细胞毒活性和抗炎活性。     

Analysis of Similarities and Differences between Coronavirus Disease 2019 and Severe Acute Respiratory Syndrome

Both coronavirus disease 2019 (COVID?19) and severe acute respiratory syndrome (SARS) are epidemic, contagious, sudden, and publicly harmful diseases. The whole?genome nucleotide identity of the pathogens causing the two diseases reached 79.5%. The mechanism and treatment of COVID?19 are still under investigation. Combining the experiences of SARS prevention and treatment in 2003, and the case data and literature of COVID?19, the similarities and differences between the two diseases in terms of causes, susceptible people, characteristics, dialectical mode, and treatment were analyzed. The two diseases are both plagues in terms of Chinese medicine. The cause of SARS was “heat poison,” and its pathogenesis was “heat poison, stasis, and qi and yin deficiency.” Therefore the treatment regimen was mainly to clear away heat, detoxicate, and expel evil. While the cause of COVID?19 was “wet poison,” and its pathogenesis was “wet, poison, heat, stasis, close, syncope, and yang collapse.” Hence the basic treatment strategy was to declare lung and remove dampness. Treatment of COVID?19 was clearing away evil qi as soon as possible, with the basic treatment regimen, which was declaring lung, removing dampness, and dispelling the evil. Combined with Traditional Chinese medicine’s (TCM’s) understanding and experience in SARS prevention and treatment, and Chinese clinical cured cases, we try to provide strategies for people all over the world to understand and respond to COVID?19, through the analysis and comparison. To improve COVID-19 prevention and treatment regimen and give full play to the advantages of TCM.     

阿帕替尼治疗晚期及术后复发肺肉瘤样癌的疗效分析

目的探索阿帕替尼治疗晚期及术后复发肺肉瘤样癌的疗效。方法收集2016年6月至2019年8月Ⅲ~Ⅳ期及术后复发的肺肉瘤样癌患者21例,口服阿帕替尼(250~425 mg/d)治疗,30 d为1个疗程,观察并分析疗效及评价安全性。结果21例患者中,完全缓解(CR)为0,部分缓解(PR)为14.3%(3例),稳定(SD)为33.3%(7例),疾病进展(PD)为52.4%(11例);客观反应率(ORR)为13.3%(3例),疾病控制率(DCR)为47.6%(10例)。中位总生存期(mOS)为4.6个月,中位无进展生存期(mPFS)为1.0个月。病灶≥6 cm(或≥5 cm)较<6 cm(或<5 cm)平均OS明显缩短,差异有统计学意义(P<0.05);术后分期Ⅰ~Ⅱ期较Ⅲ~Ⅳ期平均OS明显延长(P<0.05)。位于中央的病灶较周围的病灶平均OS明显缩短,差异有统计学意义(P<0.01)。性别、年龄(>60岁,≤60岁)、吸烟史(是/否)对疗效影响差异无统计学意义。常见不良反应包括高血压38.1%(8例)、蛋白尿23.8%(5例)、手足综合征28.6%(6例)、腹泻28.6(6例)、骨髓抑制38.1%(8例)。结论阿帕替尼治疗晚期及术后复发肺肉瘤样癌具有一定疗效,不良反应可控,病灶大小、位置及分期可能是疗效的独立影响因素。     

超高CD34+采集的动员方案序贯二次自体造血干细胞移植治疗难治性 霍奇金淋巴瘤

目的:探讨超高CD34+采集的动员方案后序贯二次自体造血干细胞移植治疗难治性霍奇金淋巴瘤的疗效和安全性。方法:对1例经过多疗程一线、二线、新药、免疫等均难治的霍奇金淋巴瘤患者，予以IA+C方案化疗+G-CSF动员干细胞后采集出超高水平CD34+细胞，之后行自体造血干细胞移植，移植后获得完全缓解，再予序贯第二次自体造血干细胞移植进行巩固治疗。结果:总计输注单个核细胞数13.67×108/kg，CD34+细胞48.68×106/kg，第一次自体造血干细胞移植术后第7天造血功能恢复，复查全身PET-CT提示获得完全缓解，第二次自体造血干细胞移植术后第8天造血功能恢复，两次自体造血干细胞移植相关并发症均在可控范围内。结论:超高CD34+细胞采集的IA+C方案化疗+G-CSF动员可以让患者有机会进行多次自体造血干细胞移植，是临床动员的创新方案。对于难治性霍奇金淋巴瘤，序贯二次自体造血干细胞移植可达到更深层次缓解，且安全性较高，延长患者无疾病生存期及总生存期，为难治性霍奇金淋巴瘤治疗提供更多临床依据。