激素序贯加中药法治疗过度减肥引起卵巢早衰55例分析

目的 探讨激素序贯加中药治疗过度减肥引起卵巢早衰患者的可行性.方法 对85例过度减肥引起卵巢早衰患者分为两组,治疗组55例以激素序贯加中药周期疗法,辅以合理膳食、精神及心理康复治疗.对照组30例常规激素序贯治疗,两组均连续治疗3个月经周期为1疗程,治疗 2个疗程3个月比较治疗效果.结果 治疗组55例中48例（87.27 %）体重增加,对照组30例中10例（33.3%）体重增加,差异有统计学意义（χ2=4.26,P＜0.05）.治疗前后体重、腰围、臀围差异均有统计学意义（P＜0.05 ）.结论 激素序贯加中药治疗作为综合辅助治疗的一种手段,具有恢复体重、调节恢复月经周期等作用,是一种很好的辅助治疗方法.     

卵巢早衰病因及治疗研究进展

卵巢早衰以低雌激素及高促性腺激素为特征,40岁前出现卵巢衰竭。卵巢早衰的病因复杂,可由遗传因素、自身免疫性疾病、医源性因素、心理因素、环境因素和感染等引起。但是大多数卵巢早衰为特发性的,原因不明。卵巢早衰危害妇女健康,近年来其发病率有逐年上升的趋势,治疗上效果不理想。通过对近年来卵巢早衰的原因及治疗方法的研究,以寻求预防、治疗、改善临床症状等相应的对策。     

卵巢早衰的病因学研究进展

卵巢早衰是一种多病因引起的以低雌激素和高促性腺激素为特征,40岁之前出现的卵巢功能衰竭,其相关病因涉及遗传学因素,自身免疫因素,酶学障碍,原始卵泡储备过少、卵泡闭锁或耗竭过快,医源性因素,环境及感染因素,心理因素等.但大多数卵巢早衰为特发性、原因不明.卵巢早衰危害妇女健康,近年来其发病率有逐年上升的趋势,治疗效果不理想.现对其病因学研究进展作以综述.     

中医疗法治疗卵巢早衰的临床观察

目的 观察中药益肾汤治疗卵巢早衰的疗效。方法 将85例卵巢早衰患者,随机分为治疗组和对照组。治疗组给予中药益肾汤治疗,对照组给予人工周期激素治疗。治疗3个月（1个疗程）后,对临床总体疗效及血清内分泌（FSH、LH、E2）的水平进行比较。结果 治疗组总有效率为81.39%,对照组总有效率为54.76%,2组有效率经检验（P〈0.05）,差异有统计学意义。2组治疗前后FSH、LH、E2都有较好的改善（P〈0.05）,但治疗组与对照组比较差异无显著性（P〉0.05）。结论 中药益肾汤治疗卵巢早衰的临床疗效肯定,能提高患者生存质量,可作为临床治疗卵巢早衰的辅助用药。     

卵巢早衰的中医辨证分型治疗临床观察

目的:探讨中医辩证论治,中药多系统、多环节的整体调节对卵巢早衰的作用.方法:对卵巢早衰患者进行中医辨证分型为:肾阳虚弱型,肝郁肾虚型,阴火血虚型.用中药多系统、多环节的整体调节对患者进行2-12个月的治疗.结果:患者临床症状及体征消失或改善,血清激素测定促卵泡生成素(FSH)、促黄体生成素(LH)下降,月经较前有规律....     

巢衰复元汤治疗卵巢早衰38例临床观察

目的 观察巢衰复元汤治疗卵巢早衰的临床疗效.方法 治疗组38例运用中药方剂巢衰复元汤(自拟)治疗;对照组19例采取激素替代疗法.均治疗5个疗程,治疗结束3个月后进行疗效比较.结果 治疗组总有效率为71.1%,对照组为36.9%,差异有显著意义(P＜0.05).治疗组症状总改善率为61%,对照组为17%,差异有非常显著意义(P＜.01).结论 巢衰复元汤治疗卵巢早衰疗效显著,中药疗效肯定.     

免疫性卵巢早衰合并精神心理问题中西医研究进展

卵巢早衰是妇科临床常见的内分泌疾病,归属于中医的"血枯""经闭"等,其病因复杂,约20%的卵巢早衰与自身免疫异常相关。随着生物-心理-社会医学模式的推进,免疫性卵巢早衰患者的精神心理健康日益受到人们的关注。而免疫性卵巢早衰发病机制尚不明确,目前还没有统一的治疗原则。临床除使用激素替代等常规疗法外,还包括免疫抑制等治疗。然而使用医学激素的弊端以及免疫抑制剂的并发症,限制了其在临床上的应用范围。合并严重精神心理问题的患者除常规心理干预外,需精神类药物治疗,但副作用较大。中医以补肾活血为根本大法,配以健脾、疏肝。导师在此基础上提出宁心安神法,疗效确切。中西医治疗各有优势,较西医治疗,中医药具有广泛性且毒副作用小,治愈率高,取得了显著成效。文章整理、分析近年来中西医治疗免疫性卵巢早衰合并精神心理问题的治疗方法及疗效,现综述如下。     

卵巢早衰21例

卵巢早衰（POF）是指在40岁以前由于卵巢功能衰竭所致的高促性腺激素闭经,以继发闭经、低雌激素等为特点。卵巢早衰目前发病率约为1％～3％,在闭经患者中占2％～10％,近年来发病率有上升趋势,其病因包括自身免疫性、遗传性染色体异常,特发性及医源性因素等,卵巢早衰妇女如何恢复排卵及妊娠仍是当前的重要课题,为此,我们采用激素治疗,取得了较满意的效果,现报道如下。     

卵巢早衰的中、西医治疗

卵巢早衰（POF）可由遗传、免疫、代谢、心理、感染等因素引起,其实质是卵巢储备功能降低,抑制素B、抗苗勒氏管激素为早期诊断POF提供了可靠的依据。西医治疗多采用激素替代疗法、基因治疗、免疫治疗等。中医认为POF的病机核心在于肾,与心、肝、脾有密切关联。中医药有明显的调节内分泌能力,对卵巢早衰具有防治作用。     

坤泰胶囊治疗卵巢早衰的临床观察

目的 观察坤泰胶囊治疗卵巢早衰的疗效方法 2005年1月-2008年2月进行了坤泰胶囊治疗卵巢早衰的临床研究. 65例患者按自愿分为2组,治疗组35人,为坤泰胶囊结合周期性激素替代治疗(HRT),对照组30人,为单纯周期性激素替代治疗.结果 治疗组有效率为97.14%,对照组有效率为65.71%,坤泰胶囊结合周期性激素替代治疗与单纯周期性激素替代治疗方案两组比较有差异性,有统计学意义.结论 坤泰胶囊治疗卵巢早衰有较好的疗效,能改善患者生活质量,有临床推广意义.     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.