基于扶阳理论辨治痛风的应用探讨

痛风乃风湿科常见疾病之一，急性发作期关节红肿灼痛明显，病程迁延难愈，给患者带来极大痛苦。中医药治疗痛风具有良好的临床疗效，目前急性期多从湿热、痰瘀等立论，慢性期以脾肾亏虚为主，对扶阳法应用于痛风的诊治鲜有提及，但基于历代典籍论述及临床所见，扶阳法在痛风的诊治中亦有一定应用机会，故在临床基础上结合文献研究，从扶阳理论探讨痛风的病因病机及诊治，以期进一步补充痛风的中医基础理论，完善其辨治方案，提高中医药辨治痛风的临床疗效。     

施仁潮应用丹溪痛风方治疗痛风经验

<正>施仁潮主任中医师,从事中医临床30余年,长于诊治痛风、类风湿关节炎、强直性脊柱炎等,临床运用"丹溪痛风方"治疗痛风取得显著疗效。介绍如下。1病因病机元代名医朱丹溪在《格致余论》中设有"痛风论"专篇,《丹溪心法》设有痛风专论,对痛风有深入阐述。丹溪说:"痛风者,四肢百节走痛,方书谓之白虎     

中西医结合治疗痛风65例临床观察

目的探讨中西医结合治疗痛风的疗效。方法全部病例在中医辨证治疗的基础上,分别加用消炎痛片、别嘌醇片、碳酸氢钠片治疗。结果治疗痛风65例,临床痊愈30例,好转33例,无效2例,总有效率96.9%。结论用中西医结合方法治疗痛风,疗效较理想。     

原发性痛风和痛风肾病的临床研究

目的了解原发性痛风与痛风肾病的临床特点以及肾损害的危险因素。方法回顾性分析10年间共诊治的原发性痛风病人328例,以第一跖趾关节发作最常见,16.5%的病例出现肾损害,肾损害者病程较长。结果在嗜烟、酒,痛风结节、高血压、高脂血症、高尿酸血症、典型的痛风X线征,血、尿β2微球蛋白升高等方面的发生率显著高于无肾损害者。结论痛风肾病的危险因素可能除高尿酸血症外,还与病程、高血压、高脂血症以及嗜烟酒等有密切关系。     

吕承全治疗痛风经验

吕承全主任医师为首批全国名老中医 ,出身中医世家 ,幼承家学 ,从事中医临床工作 60余载 ,治学严谨 ,学验俱富 ,辨治内科疑难杂病独具匠心。现将其诊治痛风的经验介绍如下。1　清热利湿治其标痛风是由于嘌呤代谢紊乱 ,导致血清尿酸含量增高 ,伴结缔组织内尿酸钠结晶沉着的疾病。临床上以高尿酸血症、特征性急性关节炎反复发作和痛风石形成为特点 ,严重者可致关节畸形、活动障碍、急性梗阻性肾病、尿酸性肾结石或痛风性肾病。而急性关节炎是原发性痛风最常见的首发症状 ,祖国医学认为本病病因病机不外湿、热、痰、瘀、虚。吕老根据临证多年经…     

双源CT在痛风结石检测中的临床应用

目的：通过双源CT应用双能量痛风结石识别技术显示痛风结石,研究双能量痛风结石检测对临床痛风诊断的敏感性。方法：以76例临床有关节痛并怀疑为痛风的患者为病例组,收集其临床检查资料,并行双侧膝关节、踝关节、脚趾关节的双源CT双能量扫描,另设对照组40例因临床需要行双侧膝关节、踝关节、脚趾关节的非痛风患者,将采集数据导入GOUT痛风结石识别软件分析,由两名高年资影像诊断医师进行读片与分析,获得患者检查部位是否存在绿色结晶沉积、沉积部位、结石数量等数据。将病例组阳性病例与临床体格检查发现病例及对照组数据的对比,病例组所有病例最终经临床按美国风湿病学会于1977年制定的诊断标准为金标准确诊,确定双源CT双能量痛风结石识别技术对痛风结石诊断的敏感性。结果：通过双源CT双能量扫描在76例临床怀疑痛风患者中共发现72例有痛风结石存在,临床最终确诊病例67例,诊断敏感性为93％。对照组未发现痛风结石。结论：双源CT应用双能量痛风结石识别技术能提高临床痛风结石诊断的敏感性。     

清痹膏局部外敷治疗湿热蕴结证型痛风58例临床观察

痛风是由于嘌呤代谢紊乱导致血尿酸持续升高,并造成组织或器官损伤的一组代谢性疾病.临床以高尿酸血症、急性关节炎反复发作、晚期关节僵硬畸形等为主要特征,可伴有痛风石沉积、痛风性肾病和尿酸性尿路结石[1].笔者采用常规治疗基础上加用清痹膏局部外敷治疗痛风58例,效果明显,特报道如下: 1 材料与方法 1.1 临床资料:共入选病例120例,所有入选病例均来自我院2012年-2016年住院病人,中医辩证均为湿热蕴结证型.     

壮医排毒扶正疗法防治痛风的探讨

西医叫"痛风",中医属"痹症",壮医属"发旺",这里壮医指的毒应是湿毒、热毒、酸毒等浸到体内再则病从口入,经谷道、水道产生酸毒,才产生"发旺"这个病.根据壮医传统组方整理、改进药方,配制成壮医排毒胶囊内服排毒并结合茶疗、外洗,结合中医把脉、望诊等传统诊断方法和中医传统配方,利用西医生化指标的检验,针对患者不同的具体情况微调药方,固本培元,祛除邪毒,使气道、水道、谷道通畅,通则不痛,达到天地人三气同步,从而有效防治痛风.通过诊治300多名痛风患者,疗效显著,并根据临床情况不断改进药方,简化排毒过程和程序,缩短治疗时间.结果 表明,壮医排毒疗法对痛风具有较好疗效,有效率达90%以上.     

王钢治疗痛风经验

介绍王钢名中医治疗痛风的经验。由于近年来生活及饮食习惯的改变,使痛风的发病率呈逐年上升趋势,王主任根据多年诊治经验认为痛风是本虚标实之证,其病理机制在胃肠,基本病机为先天禀赋不足,或后天调摄失养,加之外感风寒湿热之邪致脾胃运化失常。因此王主任在治疗上常以清热化湿祛浊、健脾通络止痛为基本法则,随证灵活调整用药,常能取得满意的临床疗效。     

痛风的临床类型与诊断探讨（附468例痛风临床观察）

结合４６８例痛风临床，分析痛风的发生发展五个阶段，认为把痛风分为炎症、砂砾、异常、混合四个类型更利于痛风的诊治和科研。     

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.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

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.