尿酸性肾病中医分型与氧化应激指标的相关性研究

目的：探讨尿酸性肾病中医分型与氧化应激相关性。方法：采用回顾性分析方法对2017年12月至2019年9月北京中医药大学第三附属医院收治的尿酸性肾病患者105例进行研究，选择同时期正常健康者105例作为对照，参考《中药新药临床研究指导原则》将105例尿酸性肾病和临床常见证型相结合，分成脾肾气虚18例、气阴两虚证19例、肝肾阴虚16例、阴阳两虚12例、湿热蕴结19例、瘀血阻滞17例、痰浊内阻13例，均在入院次日清晨空腹抽取静脉血，检测氧化应激氧化应激、肾功能损害指标，比较不同组别在氧化应激指标含量水平变化情况，比较中医分型和氧化应激、肾功能损害指标水平变化。结果：1）尿酸性肾病组总抗氧化能力（T-ACO）、晚期蛋白氧化物（AOPP）、血清丙二醇（MDA）、超氧化物歧化酶（SOD）含量水平分别为（19.45±3.42）U/mL、（42.45±3.53）μmol/L、（4.52±1.23）nmol/L、（76.78±5.64）U/mL，正常对照组则分别为（10.76±1.31）U/mL、（20.84±1.28）μmol/L、（2.13±0.76）nmol/L、（130.85±16.75）U/mL，尿酸性肾病组T-ACO、AOPP、MDA较正常对照组显著偏高，SOD显著偏低（P<0.05）。2）虚证中阴阳两虚证SOD含量上较其他证型均偏低，而MDA、T-AOC、AOPP、胱抑素C（CysC）、β2微球蛋白、尿微量白蛋白（UMALB）、蛋白尿发生率则较其他证型均偏高，差异均有统计学意义（P<0.05），实证中瘀血阻滞证SOD含量较其他证型均偏低，而MDA、T-AOC、AOPP则较其他证型均偏高，差异均有统计学意义（P<0.05）。结论：尿酸性肾病中医分型的阴阳两虚证、瘀血阻滞证氧化应激水平、肾损害指标均显著升高，可结合该实验室检查进行临床干预。     

Copper and Zinc Levels in Myelodysplastic Syndrome Patients versus Healthy Subjects

Background: Myelodysplastic syndrome (MDS) is a heterogeneous hematological disease and certain serum factors are assumed to be involved in its pathogenesis and progression. Given this, our aim was to comparatively investigate the copper, zinc, and iron levels in MDS patients and healthy individuals. Methods: This case-control study was conducted on 31 patients with MDS (according to the WHO criteria after investigating laboratory tests such as peripheral blood smear and bone marrow aspiration) attending Bahonar Hospital, Kerman, Iran, and 31 healthy subjects from 2016 to 2018. The levels of copper, ceruloplasmin, zinc, ferritin, and iron were compared between the two groups. Results: Among the MDS patients, five individuals (16.13%) had low serum copper level (mean: 67.8 ± 4.35 µg/dl). Serum copper level was 111.3 ± 27.7 and 138.3 ± 26.6 in case and control groups, respectively (P = 0.0001). The serum zinc level and bone marrow iron level were also significantly different between the two groups (P < 0.05). Conclusion: Overall, it can be concluded that because only a small proportion of the MDS patients enrolled in this study were found to have lower copper levels compared with the MDS patients population, further studies with a larger sample size and also clinical trials in MDS patients with serum zinc, and copper deficiency are recommended, and post-treatment hematological reassessment would also be beneficial to achieving more definitive results.     

脂蛋白肾病1例报道及文献复习

近期重庆市中医院肾病科收治脂蛋白肾病(Lipoprotein glomerulopathy,LPG)1例。现回顾分析病例资料、中西医诊疗及随访情况,并进行文献复习、中医传统理论阐述及讨论。以提高临床对中医药诊治该病的认识。     

中药雾化吸入联合常规疗法与护理措施干预甲状腺癌术后声音嘶哑效果分析

目的:观察在常规治疗与护理基础上加用中药雾化吸入治疗甲状腺癌术后声音嘶哑的效果。方法:纳入120例气阴两虚型甲状腺癌术后声音嘶哑患者,应用随机数字表法分为2组各60例,2组均采用常规治疗与护理措施干预,观察组加用中药雾化吸入治疗,2组疗程均为1个月。治疗前后评价2组患者的声音嘶哑情况评分,评价患者在观察期的用药依从性,出院前评价护理满意度,并比较2组的治疗效果。结果:治疗1个月后,观察组临床疗效优于对照组,差异有统计学意义(P<0.05)。观察组患者的用药依从性情况较好,绝大多数患者能够按时按量用药,不受症状波动的影响,2组比较,差异有统计学意义(P<0.05)。观察组护理满意度高于对照组,差异有统计学意义(P<0.05)。结论:在常规治疗与护理基础上加用中药雾化吸入干预甲状腺癌术后声音嘶哑,可有效改善声音嘶哑、提高疗效,提高患者的用药依从性和对护理措施的满意度。     

Update on pediatric corneal diseases and keratoplasty

Managing pediatric corneal disorders is challenging as the prognosis of pediatric keratoplasty depends on several factors. Advancements in the genetic basis of congenital corneal diseases and investigations in congenital corneal conditions provide a better understanding of pediatric corneal conditions. Surgeons performing keratoplasty in children now have a choice of various techniques. Evolving surgical techniques of anterior lamellar and endothelial keratoplasties have expanded the management interventions in these pediatric corneal morbidity conditions; however, considerable concerns still exist in association with corneal transplantation in infants and children. Outcomes in pediatric keratoplasty depend upon the preoperative indications, the timing of surgical intervention, intraoperative and postoperative factors including the patient/care givers’ compliance. Factors such as low scleral rigidity, higher rate of graft failure, need for frequent examinations under anesthesia, and difficulty in optimal visual acuity assessment still remain a considerable challenge in pediatric scenarios. In children, deprivation amblyopia as a result of the corneal opacification can adversely affect visual development, causing dense amblyopia. Outcomes to surgical interventions for management of corneal opacification in children are further compromised by the preexisting amblyopia apart from the concerns of refractive outcome of the graft. Graft rejection, graft infection, amblyopia, and glaucoma continue to be serious concerns. In recent years both anterior and posterior lamellar keratoplasty techniques are being increasingly performed in pediatric eyes, which offer advantages in the form of lower risk of graft rejection. The timing of surgery, careful case selection, cautious intraoperative approach, and optimal postoperative management can improve the anatomical and functional outcome in difficult cases.     

从中医“阳气亏虚，痰瘀内阻”理论探讨中医药防治心肌缺血再灌注损伤的机制＊

目的 从文献探讨中医“阳气亏虚，痰瘀内阻”理论防治急性心肌梗死（Acute myocardial infarction，AMI）后心肌缺血再灌注损伤（Myocardial ischemia reperfusion injury，MIRI）的机制，为其科研及防治提供依据。方法 检索中国知网数据库、万方数据库、NCBI数据库从建库到2020年6月14日有关MIRI的文献，总结MIRI的发病机制及中医证治的新观点，分析可信度较高的相关实验数据，对运用中医“阳气亏虚，痰瘀内阻”理论防治MIRI进行探讨。结果 文献表明温阳化气、活血化瘀、祛痰化浊的中医方药可通过抑制细胞内Ca²⁺超载，稳定线细胞膜，减少氧自由基的生成，改善细胞能量代谢等多条途径参与缺血心肌的保护作用。结论 MIRI的发病机制文献表明，涉及多种病因，中医药可通过多靶点、多路径参与对MIRI的防治，且可能对MIRI的临床辨证论治提供理论依据。     

黄芪建中汤对脾胃虚寒证胃溃疡大鼠的影响

目的探讨黄芪建中汤对脾胃虚寒证胃溃疡大鼠的影响。方法将SD大鼠随机分为正常组、模型组、埃索美拉唑组(4.17 mg/kg)及黄芪建中汤低、高剂量组(9.27、18.54 g/kg)。采用番泻叶(10 m L/kg)联合游泳力竭法建立脾胃虚寒证候模型,无水乙醇(10 m L/kg)联合阿司匹林肠溶片(200 mg/kg)建立胃溃疡模型。观察并记录大鼠的整体状态、体质量、进食量、饮水量和肛温,肉眼及HE染色观察胃黏膜组织形态学损伤,测量胃液总酸度和胃蛋白酶活性,ELISA法检测大鼠血清IL-4、IL-10、NO和TNF-α水平,qRT-PCR和免疫组化法分别检测TLR-2、MyD88 mRNA及蛋白表达。结果与模型组比较,黄芪建中汤组大鼠体质量、进食量、饮水量和肛温均上升(P<0.05,P<0.01),溃疡指数下降(P<0.01),胃酸总酸度和胃蛋白酶活性均降低(P<0.01),血清TNF-α水平下降(P<0.05、P<0.01),IL-4、IL-10和NO水平上升(P<0.05、P<0.01),胃组织中TLR-2、MyD88 mRNA及蛋白表达下调(P<0.01)。结论黄芪建中汤对脾胃虚寒型胃溃疡大鼠有显著的疗效,其作用机制可能通过调节TLR-2/MyD88信号通路,影响炎性因子表达,下调黏膜攻击因子水平,从而加速胃黏膜溃疡修复。     

重症肺炎合并应激性溃疡出血的中医证候研究

目的：初步探索重症肺炎合并应激性溃疡出血的中医证候及主要证型，为辨证施治提供依据。方法：选取2014年1月1日至12月31日北京中医药大学东方医院收治的重症肺炎合并应激性溃疡出血患者60例作为研究对象。对主要症状体征直接辨证，对伴随症状体征采用因子分析寻找该疾病的常见中医证候，并统计其分布特点。结果：本病涉及的主要脏腑为肺、脾，主要证候符合痰热蕴肺证特点，伴随症状体征辨证显示气阴亏虚、肺脾不足兼见痰浊、瘀血的特点。结论：重症肺炎合并应激性溃疡出血初期以痰热壅肺为基础证型、核心证型，在此基础上可见气阴两虚、肺脾不足的证候表现，同时兼见痰湿、血瘀之象，病性虚实夹杂，病位在肺脾。     

补气养阴降糖饮联合二甲双胍治疗老年2型糖尿病的疗效观察

目的:观察补气养阴降糖饮加减联合二甲双胍治疗老年2型糖尿病(气阴两虚证)的效果。方法:选取2018年4月至2019年10月北京市和平里医院收治的老年2型糖尿病(气阴两虚证)患者84例作为研究对象,随机分为对照组和观察组,每组42例。2组均予以基础治疗,对照组予以二甲双胍口服,观察组予以补气养阴降糖饮加减联合二甲双胍治疗。比较2组治疗前后主症、次症及总评分、糖代谢水平、临床疗效、胰岛素抵抗指数水平及不良反应。结果:治疗后2组主症、次症及总评分,糖代谢水平、胰岛素抵抗指数水平均下降,且观察组较对照组降低的更为明显,差异均有统计学意义(P0.05);治疗后观察组总有效率高于对照组,差异有统计学意义(P0.05);观察组不良反应发生率与对照组比较,差异无统计学意义(P0.05),且不良反应均轻微。结论:对老年2型糖尿病气阴两虚证予以补气养阴降糖饮加减联合二甲双胍可有效控制症状,改善糖代谢,增强临床疗效,减轻胰岛素抵抗,且安全。