“消银解毒饮”对银屑病血热证外周血淋巴细胞调控作用研究

目的：观察正常人及银屑病患者应用消银解毒饮治疗前后外周血T淋巴细胞及共刺激因子表达的变化，探讨“消银解毒饮”对银屑病血热证外周血淋巴细胞调控作用。方法：治疗组给予连续8周消银解毒饮治疗，用流式细胞术检测，与对照组相互比较外周血T细胞亚群及共同刺激分子CD28、CD80、CD86的表达情况。结果：治疗组治疗后皮损评分降低；治疗前后与正常人相比CD3+、CD4+细胞及CD4+/CD8+降低，CD8+细胞升高；CD28疗前高于、疗后低于正常组；CD86治疗前后均明显高于正常组；CD80正常组与治疗前均无明显统计学意义，治疗后有下降的趋势。治疗组治疗前、后外周血T细胞亚群CD3+、CD4+、CD8+、CD4+/CD8+和共刺激因子CD28、CD80、CD86均无明显的统计学意义。结论：消银解毒饮临床疗效肯定；银屑病患者外周血T细胞亚群及共刺激因子的表达存在异常；患者临床症状的好转与外周血T细胞亚群及共刺激因子表达的改变是否平行相关尚不确定。     

“治未病”思想在老年高血压病防治中的应用探讨

老年高血压病以肾气亏虚为主要病机,具有特殊的发病基础、临床症状、传变规律和预后。以"治未病"思想为指导,在老年高血压病发生、发展、预后的各个阶段进行提前干预,有利于扶助正气,增强抗病能力,延缓病情进展。具体而言,未病之时,应通过调整生活方式、服用中药保养和培补肾气,做到未病先防。已病之时,既病防变,阴阳俱虚者,治以补益肾气,方选肾气丸加减;肾阴虚者,治以滋阴补肾,方选左归丸合天麻钩藤饮加减;肾阳虚者,治以温补肾阳,方选右归丸加减。疾病初愈之时,继续以中药补肾虚、调气血,同时避免六淫邪气与情志内伤对机体的损害,以防疾病复发。     

右归丸治疗脾肾阳虚型老年功能性便秘的临床观察

目的:观察右归丸加减治疗脾肾阳虚型功能性便秘(CFC)的临床效果以及对血清超氧化物歧化酶(SOD)和丙二醛(MDA)的影响。方法:将120例CFC患者采用随机按数字表法分为对照组和治疗组各60例。对照组参照《中国慢性便秘诊治指南》治疗,包括调整生活方式;通便药采用酚酞片口服,100 mg/次,2次/d;促动力药采取多潘立酮片,1片/次,3次/d,饭前30 min服用;治疗组在对照组治疗的基础上采用右归丸加减,1剂/d,分2次内服,所有患者均治疗4周。对两组治疗前后CFC临床症状进行评分比较,采用中文版健康调查简表(SF-36)评价两组患者生活质量;检测两组治疗前后血清SOD和MDA水平。结果:治疗组临床总有效率为98.33%,对照组为85%,治疗组优于对照组(P0.05);治疗组治疗后CFC临床症状评分均低于对照组(P0.01);治疗组治疗后SF-36量表各项评分均明显高于对照组(P0.01);治疗后治疗组SOD水平明显高于对照组,MDA水平低于对照组,比较差异均有统计学意义(P0.01)。结论:在西医治疗的基础上,采取右归丸加减治疗脾肾阳虚型CFC能显著改善患者临床症状,提高临床治疗效果,其作用机制可能与升高血清SOD水平和降低MDA水平有关。     

右归丸补肾填精的药理作用

目的:以下丘脑-垂体-性腺轴为基础,探究右归丸对肾阳虚大鼠的药理作用,探讨其补肾填精的作用机制。方法:SD大鼠60只,采用氢化可的松建立肾阳虚模型大鼠,随机分为6组,分别为正常组、模型组、甲基睾酮(0.5 g·kg-1)组、右归丸低、中、高剂量组(0.5,1.0,2.5 g·kg-1),每组10只。造模后连续ig给药30 d,分别于给药第15,30天进行强迫负重游泳实验;第30天,眼球取血,放射免疫分析法检测大鼠血清睾酮(testosterone,T)、雌二醇(estradiol,E2)的含量;采用RT-PCR法检测各组大鼠下丘脑、垂体和靶腺(睾丸)钙调蛋白(Ca M)mRNA的表达。结果:与正常组比,模型组大鼠的负重游泳时间减少(P0.05),明显升高血清中E2的激素水平及降低T的激素水平(P0.05),明显升高下丘脑、垂体、睾丸中Ca M mRNA的表达(P0.05);与模型组比,甲基睾酮组、右归丸低、中、高剂量组可明显提高肾阳虚模型大鼠的负重游泳时长(P0.05),给药20 d后其体能趋于正常;给药20 d后甲基睾酮组、右归丸低、中、高剂量组可明显降低血清中E2的激素水平及升高T的激素水平(P0.05),明显降低下丘脑、垂体、睾丸中Ca M mRNA的表达(P0.05)。结论:右归丸可通过调节机体下丘脑-垂体-性腺轴中钙调蛋白基因表达,改善阳虚大鼠激素水平,逆转肾阳虚状态,具有补肾填精的作用。     

右归胶囊治疗弱精子症的临床疗效观察研究

目的:探讨右归胶囊对弱精子症患者精子存活率及活力的影响。方法:2009年4月至2010年5月就诊的不育患者中,将弱精子症患者80例随机分为治疗组和对照组,分别服用右归胶囊和五子衍宗丸,治疗周期为3个月。治疗前后,检测患者精子存活率及其活力。结果:右归胶囊组治疗前精子存活率、a级、a+b级精子百分率分别为31.9%±16.9%,8.2%±3.7%,15.7%±13.9%;治疗后分别为65.7%±13.1%,22.5%±9.1%,47.6%±15.8%,五子衍宗丸组治疗前精子存活率、a级、a+b级精子百分率分别为31.7%±17.0%,7.9%±4.5%,16.9%±13.6%;治疗后分别为38.1%±11.1%,13.2%±6.8%,24.1%±10.9%。两组治疗前与治疗后比较均有显著性差异(P<0.05),治疗后两组间比较有显著性差异(P<0.05)。结论:右归胶囊可提高弱精子症患者的精子存活率及活力,疗效优于五子衍宗丸。     

左归丸、右归丸对老年大鼠海马、杏仁核氨基酸类和单胺类神经递质含量变化的影响

目的 观察左归丸、右归丸对老年大鼠海马、杏仁核氨基酸类神经递质Asp、Glu、Gly、GABA和单胺类神经递质5-HT、NE含量变化的影响，探讨老年机体神经元的神经递质的变化，以及左归丸、右归丸延缓老年大鼠神经内分泌调控退化的作用机制。方法 以自然衰老大鼠为动物模型，分设4组：青年对照组、老年对照组、老年左归丸组、老年右归丸组。采用HPLC-荧光法，检测各组大鼠海马、杏仁核Asp、Glu、gly、GABA含量变化；采用ELISA法，检测5-HT、NE含量变化。结果 与青年对照组相比，老年对照组大鼠海马、杏仁核Asp、Glu、Gly、GABA含量有不同程度升高，而与老年对照组相比，两用药组含量有不同程度降低。同时，老年对照组大鼠海马NE含量减少，左归丸组能提高老年大鼠海马NE含量。而各组大鼠5-HT含量无明显差异。结论 左归丸、右归丸通过不同程度地纠正老年大鼠海马和杏仁核脑区氨基酸类和单胺类神经递质的紊乱状态，使兴奋性和抑制性神经递质趋向平衡，从而有助于改善大脑边缘系统，延缓机体衰老。     

Age at first drink and the first incidence of adult-onset DSM-IV alcohol use disorders

Background: Existing studies of the association between age at first drink (AFD) and the risk of alcohol use disorders (AUD) suffer from inconsistent levels of control and designs that may inflate associations by failure to control for duration of exposure to risk. Methods: This study examined associations between AFD (ages <15 and 15–17 vs. 18+ years) and first incidence of DSM‐IV alcohol dependence, abuse, and specific AUD criteria over a 3‐year follow‐up in a longitudinal study of U.S. drinkers 18 years of age and older at baseline (n = 22,316), controlling for duration of exposure, family history, and a wide range of baseline and childhood risk factors. Results: After adjusting for all risk factors, the incidence of dependence was increased for AFD < 15 years (OR = 1.38) and for women only with AFD at ages 15 to 17 (OR = 1.54). The incidence of abuse was increased at AFD <15 and 15 to 17 years (OR = 1.52 and 1.30, respectively). Most dependence criteria showed significant associations with AFD, but hazardous drinking and continued drinking despite interpersonal problems were the only abuse criteria to do so. All associations were nonsignificant after controlling for volume of consumption, except that AFD at all ages <18 combined was associated with a reduced likelihood of impaired control, and AFD at ages 15 to 17 was associated with lower odds of drinking more/longer than intended among heavy‐volume drinkers. In a population of low‐risk drinkers that excluded those with positive family histories, personality disorders, and childhood risk factors, there were strong associations between early AFD (<18) and the incidence of dependence (OR = 3.79) and continued drinking despite physical/psychological problems (OR = 2.71), but no association with incidence of abuse. Conclusions: There is a robust association between AFD and the risk of AUD that appears to reflect willful rather than uncontrolled heavy drinking, consistent with misuse governed by poor decision‐making and/or reward‐processing skills associated with impaired executive cognitive function (ECF). Additional research is needed to determine causality in the role of impaired ECF, including longitudinal studies with samples of low‐risk adolescents.     

Satiety testing： Ready for the clinic？

Drink tests are advocated as an inexpensive, nonivasive technique to assess gastric function in patients with a variety of upper digestive symptoms. Many patients with dyspeptic complaints will achieve satiation or develop symptoms at ingested volumes below those typically required to achieve these endpoints in controls. Substantial variation in test performance exists and a greater degree of standardization is required. Additionally, it remains unclear exactly what drink tests measure as correlations with measures of gastric sensation, accomodation and emptying are modest at best. Finally, results of drink tests do not guide therpay. At present, these tests are best reserved for research studies and are not advocated for use in clinical practice.