复方鳖甲软肝片对慢性丙型肝炎患者肝纤维化指标的影响

目的探讨复方鳖甲软肝片对慢性丙型肝炎患者肝纤维化指标的影响。方法选取因年龄、疗效差、具有禁忌证、不能耐受等原因放弃了干扰素抗病毒治疗的58例慢性丙型肝炎患者,随机分为治疗组和对照组,治疗组37例,其中男22例,女15例,对照组21例,其中男11例,女10例;对照组给予常规保肝药物如护肝片、肝泰乐等口服,治疗组在上述治疗的基础上加用复方鳖甲软肝片,4片/次,3次/d,3个月为1疗程,连用2个疗程。治疗期间避免应用其他抗肝纤维化药物及抗病毒药物。观察两组病例治疗前后肝纤维化四项指标(血清透明质酸HA、Ⅲ型前胶原PCⅢ、层粘蛋白LN及Ⅳ型胶原Ⅳ-C)的变化情况。结果治疗组治疗后与治疗前比较及对照组治疗后比较,肝纤维化指标有明显改善(P值均小于0.01)。结论不能接受干扰素抗病毒治疗的慢性丙型肝炎患者,服用复方鳖甲软肝片可以显著改善肝纤维化情况。     

强肝胶囊与小剂量γ-干扰素联合抗肝纤维化的血清学指标检测

为了解强肝胶囊与小剂量γ-干扰素联合治疗对慢性肝病病人的血清肝纤维化作用，检测透明质酸（HA）、四型胶原（CⅣ）、三型胶原（PCⅢ）和层粘连蛋白（LN））四项指标。观察组（39例）给予强肝胶囊，每日3次，每次5片，连续3个月，同时给予γ-IFN 1MU／d，30d，后隔日一次1MU，连续2个月。对照组（52例）采用常规护肝降酶等治疗。结果，治疗后观察组血清肝纤维化指标下降较对照组明显（P〈0.01）。表明强肝胶囊与小剂量γ-干扰素联合应用改善了慢性肝病肝纤维化患者血清肝纤维化指标，有助于中西医结合加强抗肝纤维化治疗。     

补肾柔肝方治疗乙肝后肝纤维化临床对照研究

目的:探讨补肾柔肝方治疗乙肝后肝纤维化的临床疗效。方法:采用随机对照的方法,将60例患者分为治疗组30例和对照组30例。治疗组给予补肾柔肝方,对照组给予复方鳖甲软肝片治疗,疗程为24周。观察两组患者的临床疗效及血清肝功能、肝纤维化指标及Fibroscan的变化。结果:治疗后治疗组和对照组相比,症状和体征改善显著,两组比较有统计学意义(P0.05);治疗组患者的HA、PШP下降幅度明显大于对照组(P0.05)。结论:补肾柔肝方治疗乙肝后肝纤维化具有较好的临床疗效,其降低肝纤维化指标HA、PШP及改善肝弹力的效果优于复方鳖甲软肝片。     

强肝胶囊联合抗病毒药物对乙型肝炎肝纤维化患者的临床疗效观察

目的 观察强肝胶囊联合核苷(酸)类抗病毒药物治疗慢性乙型肝炎肝纤维化的临床方法和效果.方法 将112例慢性乙型肝炎肝纤维化患者,采用随机原则分成治疗组和对照组,对照组给予核苷(酸)类似物抗病毒药物拉米夫定和(或)阿德福韦酯治疗,治疗组加服强肝胶囊治疗.观察两组临床症状积分变化、病毒转阴率、血清肝纤维化指标和不良反应.结果 治疗前两组各症候评分比较差异无显著性;治疗后两组各症候积分均有明显改善,治疗前后比较差异具有显著性,治疗组作用均好于对照组;治疗组HBV-DNA转阴43例(76.79％),对照组40例(71.43％),两组比较差异无显著性;两组患者治疗前肝纤维化血清学指标差异无显著性,治疗后肝纤维化血清学指标均下降,与治疗前相比差异有显著性,治疗组与对照组比较差异具有显著性.结论 强肝胶囊可以改善患者临床症状,加强抗病毒药物的疗效,而且具有明显的改善肝脏纤维化程度的作用.     

抗纤胶囊治疗慢性乙型病毒性肝炎肝纤维化

目的:观察抗纤胶囊对慢性乙型病毒性肝炎肝纤维化患者肝脏纤维硬度值、天冬氨酸氨基转移酶和血小板指数(APRI评分)、血液流变学、肝纤维化指标的干预作用。方法:70例慢性乙型肝炎患者随机分为对照组(30例)及观察组(40例)。对照组给予恩替卡韦片,观察组在对照组治疗基础上给予抗纤胶囊。比较两组患者治疗前后肝脏纤维硬度值、APRI评分、血液流变学及肝纤维化等相关指标。结果:两组患者治疗后肝脏纤维硬度值、APRI评分均低于治疗前,差异均有统计学意义(P 0. 05);观察组治疗后以上指标低于对照组治疗后,差异均有统计学意义(P 0. 05)。两组患者治疗后全血高切黏度、全血低切黏度、红细胞压积及血浆黏度水平均低于治疗前,差异均有统计学意义(P 0. 05);观察组治疗后以上指标低于对照组治疗后,差异均有统计学意义(P 0. 05)。两组患者治疗后血清透明质酸、层黏连蛋白、Ⅲ型前胶原、Ⅳ型胶原水平均低于治疗前,差异均有统计学意义(P 0. 05);观察组治疗后以上指标低于对照组治疗后,差异均有统计学意义(P 0. 05)。结论:抗纤胶囊联合恩替卡韦片可减轻慢性乙型肝炎患者肝纤维化的程度,改善肝脏微循环,延缓疾病进展。     

苦参素胶囊联合强肝胶囊治疗乙肝后肝纤维化的临床研究

目的:观察苦参素胶囊联合强肝胶囊对慢性乙肝肝纤维化的治疗效果。方法:54例慢性乙肝肝纤维化患者随机分为对照组和联合治疗组,观察治疗前、后肝功能、肝纤维化指标和HBV标志物的变化。结果:治疗后联合治疗组各项指标均较治疗前及对照组有明显改善(P<0.05或P<0.01)。结论:苦参素胶囊联合强肝胶囊可明显控制乙肝患者的肝脏炎症,显著提高抗肝纤维化作用,可抑制HBV复制且无严重不良反应。     

乙肝抗纤丸对慢性乙型肝炎血清肝纤维化指标的影响

目的:观察乙肝抗纤丸对慢性乙型肝炎血清肝纤维化指标的影响及临床疗效观察.方法:将120例慢性乙型肝炎、肝炎肝硬化患者随机分成治疗组和对照组各60例.治疗组给予口服乙肝抗纤丸3 g口服,3次/d,治疗168 d;对照组给予维生素类护保药物对症治疗168 d.观察治疗前及治疗后168 d两组患者肝功能(ALT、TBIL、ALB)、血清纤维化指标(HA、LN、PCⅢ、C-Ⅳ)变化.结果:治疗组ALB水平的变化在治疗前后具有显著差异(P＜0.01),治疗后与对照组比较亦有显著差异(P＜0.01).治疗组与对照组比较血清肝纤维化指标明显好转(P＜0.05).结论:乙肝抗纤丸可提高血清ALB,使血清肝纤维化指标下降,改善肝功能、防治肝纤维化.     

恩替卡韦联合丹参酮胶囊治疗慢性乙型肝炎肝纤维化的疗效分析

目的 探讨恩替卡韦联合丹参酮胶囊治疗慢性乙型肝炎肝纤维化的临床疗效。方法 将86例慢性乙型肝炎肝纤维化患者按照随机数字表随机分为分为观察组(n=43例)和对照组(n=43例),对照组给予口服恩替卡韦分散片治疗,观察组给予口服丹参酮胶囊+恩替卡韦分散片治疗,疗程均为48周；观察两组患者治疗前后的临床症状体征改善情况、肝功能指标、肝纤维化相关指标以及肝脏影像学指标变化情况。 结果 观察组治疗后的临床症状体征如厌食、乏力、腹胀及肝区痛的改善情况优于对照组(P＜0.05)；两组治疗后肝功能指标ALT、AST、ALB、TBIL均有显著的改善(P＜0.05),观察组的肝功能改善情况优于对照组(P＜0.05)；两组肝纤维化指标治疗后亦有显著降低,观察组肝纤维化指标改善情况优于对照组(P＜0.05)；观察组治疗后的脾脏厚度及门静脉的内径小于对照组(P＜0.05)；观察组治疗后HBeAg 转阴率高于对照组(P＜0.05),而HBV DNA 转阴率两组比较无统计学意义(P＞0.05)；结论     

益肝消癥散抗慢性肝炎肝纤维化临床研究

目的观察益肝消癥散对慢性肝炎肝纤维化的临床疗效及毒副作用,初步探讨其对慢性肝炎肝纤维化的防治作用及最佳治疗证型.方法选用符合入选条件慢性病毒性肝炎患者50例,随机分成2组,治疗组30例,服用益肝消癥散,辅以常规护肝西药;对照组20例,除不用益肝消癥散外,余与治疗组同.2组均以3个月为一疗程,观察治疗前后肝纤维化指标及反映临床疗效指标变化.结果治疗组30例,临床有效率80%;对照组20例,临床有效率50%.两者比较有显著性差异(P＜0.05);肝功能指标及肝纤维化指标治疗后均明显改善(P＜0.01),且优于对照组(P＜0.01或P＜0.05).降低肝纤维化指标疗效,以湿热中阻、肝郁脾虚、瘀血阻络证较其余两型为优.结论益肝消癥散对慢性病毒性肝炎有较好治疗效果,对慢性肝炎肝纤维化有阻逆作用,较佳治疗证型为湿热中阻、肝郁脾虚与瘀血阻络证.     

中西医结合治疗乙型肝炎肝纤维化临床观察

目的 观察中西医结合治疗乙肝肝炎肝纤维化的临床疗效.方法 60例乙型肝炎肝纤维化病例,随机分为治疗组和对照组各30例.治疗组例采用阿德福韦酯联合自拟参甲化纤方治疗.对照组例单用阿德福韦酯胶囊.观察两组治疗前后肝功能、肝纤维化及肝脾超声影像变化.结果 两组治疗后肝功能、肝纤维化及肝脾超声影像指标与治疗前比较差异均有统计学意义（P 〈 0.05或P 〈 0.01）,治疗后治疗组与对照组比较,除PC-Ⅲ无差异外,其他指标均有显著性差异（P 〈 0.05或P 〈 0.01）.结论 中西医结合治疗乙肝肝炎肝纤维化,可有效抗病毒,有效改善肝功能、肝纤维化指标,减轻脾脏厚度,减轻门静脉和脾静脉宽度.     

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.