痛风——降尿酸治疗的新策略

翻阅近几年风湿专业期刊——《中华风湿病学杂志》有关痛风的文章寥寥无几，这一冷清似与国内日益增加的痛风患者及国外投入的积极关注脱节。     

老年人痛风的临床特点及治疗

痛风的治疗已有基本的常规和策略［１,２］,然而,由于抗痛风药物较高的毒副作用及老年痛风病人常伴有高血压和肾功能不全等特点,治疗上有一定困难［３］。为防止抗痛风药物对老年患者的损害,必须仔细选择抗痛风药并调整其剂量。　　老年人痛风的特点６０岁以后发病的痛风（也称迟发型痛风）病人较少有强烈的关节剧痛,以钝痛的慢性关节炎较多见,易与常见的骨关节炎混淆,有时须经关节腔抽液检出尿酸盐结晶才确诊。在迟发痛风病人,极肥胖者并不常见［３］,但这些老人常有高血压和不同程度肾功能不全,应考虑痛风和这些伴发病治疗上的…     

痛风治疗药物新进展

痛风是最为常见的炎症性关节病,已经成为"病中之王",给患者及其家庭和社会造成极大的经济负担。据全球数据预测,2018年急性痛风药物治疗经济负担为3.37亿美元,而降尿酸药物更要高达1.9亿美元~([1])。美国风湿病协会(ACR)和欧洲抗风湿病联盟(EULAR)先后颁布了痛风治疗指南,但是其中的药物治疗并不能覆盖目前所有痛风患者,特别是严重的痛风和对目前药物有使用禁忌证的患者。为     

治疗痛风的新药

在一个新药的临床研究中．大部分患者在应用了俾哥的斯（pegloticase）数小时后尿酸水平就开始下降。这是一个由杜克大学医疗中心和一个制药公司联合开展的研究。该研究观察了41名患者。患者被随机分配．每两周接受一次4mg或8mg的治疗，或者每4周接受一次8mg或12mg的治疗。     

抗高尿酸血症追踪治疗对原发性痛风的影响

对已有10年以上抗高尿酸血症治疗历史的65例痛风患者进行重新评估.发现痛风石沉积的减少与血尿酸(SUA)浓度相关.降低SUA浓度有可能减少痛风石,但X线改变和SUA浓度不存在相关性.单独SUA浓度测定不能有效地监测痛风病变的进展.     

痛风的诊断与治疗

伴随代谢综合征发病率、老年性肾损害患病率的增加及利尿剂的频繁应用，痛风的发病率增加、发病年龄渐年轻化，不典型及难治性痛风增多。痛风的诊断除依据高尿酸血症和临床表现外，还要对其病因、分期及机体损害的部位做出判断，为治疗提供理论依据。痛风的治疗在控制高尿酸血症同时要注意保护脏器、防止急性发作。本文结合新近文献资料，主要介绍了痛风的诊断和治疗，希望对临床医师提供帮助和参考。     

痛风患者降尿酸治疗敏感性与中医证型及临床特点的相关性

目的探讨痛风患者对降尿酸药物的达标应答剂量与中医证型、临床表现、实验室检查、并发症等的相关性。方法临床随机选取痛风患者520例,按照中医诊疗方法主要分为湿热蕴结证型、痰瘀互结证型、脾虚湿困证型、气血两虚证型4个中医证型。对所有患者进行降尿酸治疗(别嘌醇片、非布司他片),在血尿酸连续3个月稳定在300～360μmol/L后记录降尿酸药物剂量,分别定义敏感组(别嘌醇片300 mg/d以内、非布司他片40 mg/d以内)、抵抗组(别嘌醇片400 mg/d以上、非布司他片80 mg/d以上或两药联合)。记录两组间的中医证型分布、病程、起始治疗的血尿酸水平、血尿素氮、全血细胞计数、尿pH值、尿比重相、关节炎发作频率、并发症(痛风石、泌尿系结石)、合并疾病(高血压、高脂血症、糖尿病、肾损伤)等情况,分析各指标与降尿酸药物达标剂量的相关性及痛风患者血尿酸达标的影响因素。结果两组病程、关节炎发作频率、合并高血压、合并高脂血症、并发痛风石、并发肾损、治疗前血肌酐水平、达标后血肌酐水平、初始血尿酸水平比较差异有统计学意义,抵抗组在各指标上明显高于敏感组。两组间中医证型分布差异有统计学意义(P0.05),敏感组以湿热蕴结证型为主,抵抗组以痰瘀互结证型为主。Logistic回归分析显示病程、合并高血压、合并高脂血症、并发痛风石、初始血尿酸水平及中医痰瘀互结证型是痛风患者血尿酸达标的影响因素。结论病程长、合并高血压及高脂血症、并发痛风石、血肌酐水平高及中医证型为痰瘀互结证型的痛风患者对降尿酸治疗的反应差,需要更大的达标剂量。     

Chinese herbal medicine for treatment of dislipidemia

Prevalence of dislipidemia is increasing rapidly in China and there has been a growing interest in Chinese herbal medicine for the treatment of hyperlipidemia both inside and outside China. In this article, lipids regulating effects of 9 herbs or their extracts and 5 herbal formulae which have been published in English-language literature are reviewed. Although evidence from animals and humans consistently supports the therapeutic activities of these Chinese herbal medicines, few multi-center large-scale clinical trials have been conducted to confirm the efficacy and evaluate their safety.     

中药验方APD-10治疗包虫病的临床观察

目的探讨中药验方APD-10治疗包虫病的疗效及机理。方法对确诊的120例包虫病患者经口服APD-10煎剂后，对治疗前后的各项临床指标与术后病理检查结果进行对比。结果服药后症状、体征减轻，62例服药90d临床治愈，42例服药120～150d临床治愈，16例有效。治疗后B超、肺部X线片及病理检查均显示囊壁变性皱缩，囊壁纤维层断裂，角质层厚薄不均，生发层细胞浊肿明显，囊腔内有大量坏死物质。结论用APD-10治疗包虫病可获得较为满意的效果。     

中草药致肝小静脉闭塞病11例临床分析

目的评估各种常规临床检测方法对中草药所致肝小静脉闭塞病（HVOD）的诊断价值,并探寻评价疾病转归及预后的方法。方法采用回顾性研究方法,分析我院近3年间服用中草药所致11例HVOD的临床表现、生化指标和影像学特点。结果所有患者均有明确用药史,7例患者服用土三七,2例患者服用雷公藤,2例患者服用不明中草药,CT对HVOD的诊断有重要意义,死亡4例患者均为重型患者。结论我国肝小静脉闭塞病的诊断应重视患者用药史,HVOD患者的疾病分型对病情评估有重要意义。     

Systematic review of Chinese herbal medicine for functional constipation

Constipation is a common gastrointestinal complaint in clinical practice, affecting an estimated 27% of the population. Many patients are disappointed by current conventional treatments and, therefore, seek help from complementary and alternative medicine (CAM). Traditional Chinese medicine, is the most important part of CAM and has been practiced for treating diseases and promoting the health of humans for thousands of years, and has become a popular alternative choice. Although there are many Chinese herbal medicine (CHM) interventions available, and some have been verified by clinical trials, their efficacy and safety are still questioned by both patients and health care providers worldwide. The purposes of this review are, first, to appraise the qualities of individual study designs in the new Cochrane approach. Second, the benefits of individual CHM interventions or individual types of CHM intervention for the treatment of functional constipation are analyzed. Finally, valid and comprehensive conclusions are drawn, if applicable, in order to make clinical recommendations.     

a-干扰素联合中药方剂治疗慢性乙型肝炎的临床研究

目的研究a-干扰素联合中药方剂治疗慢性乙型肝炎的临床疗效及其机理。方法选择慢性乙型肝炎患者134例，分别给予a-干扰素联合中药方剂或单用治疗6个月，观察患者治疗前后肝功能、乙型肝炎病毒标志物的变化情况。结果在肝功能复常方面，治疗组优于两对照组，但无统计学差异（P〉0．05）；在HBeAg、HBVDNA阴转方面，治疗组明显优于两对照组，差异有统计学意义（P〈0．01或0．05）。结论a-干扰素联合中药方剂治疗慢性乙型肝炎具有较好疗效，中药方剂能明显提高a-干扰素的抗病毒效果。     

正确认识中药的肝毒性

周光德等^[1]收集了解放军第三二医院确诊为药物性肝损伤患者100例的临床资料，中药类占24％，为各种导致肝损伤药物种类之首。林爱型^[2]综合了国内1998年至2002年发表的9篇有关药物性肝炎的报道，中药引起的肝损害占30．00％～74．14％不等，而且有逐年上升的趋势。     

活血化淤中药治疗对脂肪性肝炎患者肝组织TIMP-1和TIMP-2表达的影响

目的探索活血化淤中药对脂肪肝肝纤维化发生的干预作用,尤其是对肝组织TIMP-1和TIMP-2蛋白表达的影响。方法用免疫组化法分别测定15例脂肪性肝炎患者治疗前后肝组织TIMP-1和TIMP-2蛋白的表达。结果活血化淤药物治疗后TIMP-1和TIMP-2表达水平明显低于治疗前。对照组肝组织TIMP-1、TIMP-2表达水平无明显变化。结论TIMP-1、TIMP-2与肝纤维化形成密切相关,活血化淤中药治疗对脂肪肝患者肝内TIMP-1和TIMP-2蛋白的表达有一定的抑制作用。     

Effect of Chinese herbal medicine compound on breast hyperplasia: A protocol of systematic review

Background:Data supporting the use of Chinese herbal medicine compound (CHMC) on breast hyperplasia (BH) based on the data from previous studies. However, the results are still contradictory. Thus, this study aims to compare the results obtained for effect on case-controlled study (CCS) of CHMC on BH.Methods:This study will include CCS assessing the effect of CHMC on BH. A literature search will be carried out in Cochrane Library, MEDLINE, EMBASE, Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure from inception to the present. We will not apply language limitation to any electronic database. Study quality will be evaluated using Newcastle-Ottawa Scale, and statistical analysis will be performed using RevMan 5.3 software.Results:This study will summarize the up-to-date evidence to assess the effect of CHMC on BH.Conclusion:The results of this study may exert helpful evidence to determine whether CHMC is effective on BH.OSF registration number:osf.io/3k8ch.     

Cardioprotective effect of Chinese herbal medicine for anthracycline-induced cardiotoxicity in cancer patients: A meta-analysis of prospective studies

Background:To assess the benefits and harmful effects of Chinese herbal medicine (CHM) formulations in preventing anthracyclines (ANT)-induced cardiotoxicity.Method:The Cochrane Library, Pubmed and EMBASE databases were electronically searched for relevant randomized controlled trials (RCTs) published till December 2021 in English or Chinese-language, in addition to manual searches through the reference lists of the selected papers, and the Chinese Conference Papers Database. Data was extracted by 2 investigators independently.Result:Seventeen RCTs reporting 11 different CHMs were included in this meta-analysis. The use of CHM reduced the occurrence of clinical heart failure (RR 0.48, 95% CI 0.39 to 0.60, P < .01) compared to the control group. Data on subclinical heart failure in terms of LVEF values showed that CHM reduced the occurrence of subclinical heart failure (RR 0.47, 95% CI 0.35 to 0.62, P < .01) as well.Conclusion:CHM is an effective and safe cardioprotective intervention that can potentially prevent ANT-induced cardiotoxicity. However, due to the insufficient quality of the included trials, our results should be interpreted with cautious.