慢性胃炎的中医证型分布及主要证素的临床分析

目的探讨慢性胃炎的中医证型及主要证素分布。方法选取328例慢性胃炎患者作为研究对象,收集四诊资料并采用证素辨证方法对其证候进行分析,探讨慢性胃炎的中医证型及主要证素分布。结果慢性胃炎患者的中医证型出现频数从高到低分布情况为:肝胃不和证肝郁脾虚证脾胃虚弱证脾胃湿热证脾胃虚寒证脾胃气滞证脾胃夹湿证脾胃郁热证脾虚气滞证胃阴不足证。病位证素分布情况为:胃脾肝肾心胆肺大肠小肠,以胃、脾、肝、肾为主。病性证素分布情况为:气滞湿气虚阴虚阳虚血瘀痰热寒血虚,其中以气滞证为主。结论慢性胃炎中医证型主要为肝胃不和、肝郁脾虚以及脾胃虚弱证,病位证素以胃、脾、肝、肾为主,病性证素主要为气滞、湿、气虚、阴虚、阳虚、血瘀、痰、热、寒以及血虚。     

湿疹患者脉象的中医证型分析

目的 探讨湿疹中医不同证型脉象的变化及其临床意义.方法 选择湿疹病人214例,根据中医辨证分为脾虚湿盛型65例,湿热内蕴型76例,血虚风燥型73例.另选择健康志愿者60例作为对照组.采用脉象采集系统和临床结合的方法进行脉象的识别分析.结果 湿疹组主波幅值(h1)、重搏前波幅值(h3)、降中峡幅值(h4)、重搏波幅值(h5)与对照组比较,差异均有统计学意义(P＜0.05);湿疹组脉动周期时值(t)、主波上1/3处的宽度(w/t)与对照组比较,差异均有统计学意义(P＜0.05);湿疹组h3/h1、h4/h1、h5/h1与对照组比较,差异均有统计学意义(P＜0.05);湿疹组各证型间差异均有统计学意义(P＜0.05).结论 湿疹组脉象多项指标较正常人有显著差异性,且中医不同证型间有显著变化.     

慢性胃炎脾胃湿热证不同亚型患者三叶因子1及细胞间黏附分子1蛋白的表达

[目的]探讨幽门螺杆菌(Hp)阴性慢性浅表性胃炎(CSG)脾胃湿热证不同亚型(热重于湿、湿重于热、湿热并重型)患者三叶因子1(TFF1)、细胞间黏附分子1(ICAM-1)蛋白表达的意义。[方法]采用免疫组化SP法检测Hp阴性CSG患者脾胃湿热证27例(其中热重于湿、湿重于热、湿热并重型各9例)及正常人10例(正常组)胃黏膜TFF1I、CAM-1蛋白表达。[结果]TFF1蛋白表达:热重于湿组湿热并重组湿重于热组,但组间无明显差别;与炎症程度呈负相关(P0.01)。ICAM-1蛋白表达:湿热并重热重于湿湿重于热,但组间无明显差异。[结论]脾胃湿热证各亚型TFF1蛋白表达与炎症程度呈负相关,提示TFF1在脾胃湿热证中可能是胃黏膜局部"正气抗邪"的分子生物学基础之一。     

特应性皮炎患者的舌象图像特征与中医证型关联性分析

［摘要］　目的　分析特应性皮炎(AD)患者的舌象图像特征与中医证型的关联性。方法　选择2018年3月至2020年10月广西中医药大学第一附属医院皮肤科门诊收治的AD患者130例作为病例组,另选择同期健康体检者40名作为对照组。采集研究对象舌象图像,获得了其红绿蓝（RGB）值和色调-饱和度-强度（HSI）的色调（H）值,并分析这些特征值与中医证型的关联性。结果　130例AD患者中脾虚湿盛型49例（37.69%）,湿热内蕴型45例（34.62%）,血虚风燥型36例（27.69%）。血虚风燥型组、脾虚湿盛型组和湿热内蕴型组的R分量值显著小于对照组（P<0.05）。血虚风燥型组的R分量值和B分量值均大于脾虚湿盛型组和湿热内蕴型组,差异有统计学意义（P<0.05）。湿热内蕴型组H值显著小于对照组（P<0.05）。四组G分量值比较差异无统计学意义（P>0.05）。结论　舌诊图像参数R、G、B分量值及H值可作为AD辨证分型的客观指标,有一定的临床意义。     

593例乙型肝炎肝硬化患者中医证候特征的回顾性分析

目的：探索岭南地区乙型肝炎肝硬化的发病特征、中医证候规律,为制定及优化乙型肝炎肝硬化的临床诊疗方案提供科学依据。方法：运用回顾性研究的方法,对2002年10月-2010年4月在广东省中医院肝病科、消化科住院的593例乙型肝炎肝硬化患者的资料从人口学信息、中医证候及证型等方面进行分析。结果：593例乙型肝炎肝硬化患者中男性475例,女性118例,男女之比为4.03∶1;年龄最大92岁,最小18岁,平均（52.94士13.19）岁,30～69岁是乙型肝炎肝硬化发病的高发年龄;病程从1天（既往未做相关检查,初次发现乙型肝炎肝硬化）到50年不等,平均（11.68士10.40）年;肝功能代偿期患者96例,占16.19%,肝功能失代偿期患者497例,占83.81%。乙型肝炎肝硬化的常见症候有20余种,最常见的症状有乏力、腹胀、双下肢浮肿、身目黄染、口干口苦、胁痛、纳差、眠差、小便黄、便溏等,其中疲倦乏力、腹胀出现频率最高。单纯证型共11个,复合证型15个,辨证属于单纯证型的患者共190例（32.04%）,属复合证型的患者共403例（67.96%）。前10位的中医证型分别是（肝郁脾虚,湿瘀互结）型〉（肝郁脾虚,湿热瘀结）型〉湿热蕴结型〉（肝郁脾虚,湿热蕴结）型〉热伤胃络型〉肝郁脾虚型〉（脾气亏虚,湿浊中阻）型〉湿热瘀结型〉（脾气亏虚,湿热蕴结）型〉（肝肾阴虚,湿瘀互结）型,其中6个（6/10）属复合证型。结论：乙型肝炎肝硬化患者具有男性发病率高、年龄偏大、病程较长、住院次数较多、并发症多、死亡率高等特点。从临床证候来看,湿、热、瘀、虚是其主要的病变特点,其主要的中医证型多以复合证型为多见,（肝郁脾虚,湿瘀互结）型、（肝郁脾虚,湿热瘀结）型、湿热蕴结型、（肝郁脾虚,湿热蕴结）型等是最常见的中医证型,这与乙型肝炎肝硬化的病变阶段、病机以及发病特点密切相关。     

脾虚证各型患者与幽门螺杆菌感染情况的检测

通过采用细菌学检查方法及酶联免疫吸附试验方法对１１３例各型脾虚证患者幽门螺杆菌感染情况进行检测。结果表明：脾虚夹热型患者幽门螺杆菌感染率明显高于其他三型脾虚证患者，而脾虚肝郁型患者的感染率最低。提示脾虚夹热型患者与幽门螺杆菌感染关系密切。     

脾虚证各型患者与幽门螺杆菌感染情况的检测

通过采用细胞学检查方法及酶联免疫吸附试验方法对１１３例各型脾虚证患者幽门螺杆菌感染情况进行检测。结果表明：脾虚夹热型患者幽门螺杆菌感染率明显高于其他三型脾虚证患者，而脾虚肝郁型患者的感染率最低，提示脾虚夹热型患者与幽门螺杆菌感染关系密切。     

94例肝硬化难治性腹水患者中医证候特征分析

目的:探讨肝硬化难治性腹水患者的中医证候特征,为肝硬化难治性腹水的中医治疗提供辨证施治依据。方法:采用前瞻性流行病学调查方法,提取94例肝硬化难治性腹水患者的中医症状、体征、舌、脉等四诊信息,对患者进行中医辨证,进行统计分析这类患者的证候学特点。结果:肝硬化难治性腹水患者常见的中医证候依次为:脾虚湿阻证(80.8%),血瘀证(71.3%),湿热蕴结证(55.3%),肝气郁结证(44.7%),肝肾阴虚证(9.6%),脾肾阳虚证(4.3%)。其中同一患者常有几个证候重叠。结论:肝硬化难治性腹水患者的中医证候较少见单一证候,兼夹证多见。脾虚湿阻兼夹瘀热的复合证型,是肝硬化难治性腹水的最特征性证候。     

中医药治疗急性肝炎研究进展

1 辨证论治 李氏认为本病多属中医湿热疫毒证的范畴,临床上分4型论治:湿热兼表发黄,治以宣上透表,开泄湿热;湿热并重发黄,治以调中渗湿,疏肝利胆;热重于湿发黄,治以导下解毒,分消走泄;湿热疫毒蕴结于里,治以清利三焦,疏肝和胃。陈氏将小儿急性黄疸型肝炎分为湿热蕴结证、湿盛热轻证、寒湿困脾证3型论治,除辨证分型治疗外,第1周内另服茵陈适量、石螺适量加红糖当饮料。急性肝炎经过治     

200例酒精性肝病患者中医证候分布调查分析

目的:探索酒精性肝病的中医证候分布特点,为酒精性肝病预防及治疗提供依据。方法:运用数据挖掘技术,以因子分析优化方案和回归分析方法,对200例酒精性肝病患者的证候分布进行统计分析。结果:通过本研究获得14种常见的酒精性肝病中医证候类型,分别为肝胃不和证(6.5%)、湿热内蕴证(10.0%)、肝胃积热证(7.5%)、脾虚湿困证(6.5%)、肝胃气滞证(3.5%)、肝胃气滞阴虚证(9.5%)、脾虚气滞证(8.0%)、肝胆湿热证(9.0%)、痰湿瘀滞证(6.0%)、湿困脾胃证(5.0%)、脾虚痰湿证(10.0%)、气虚气滞证(4.5%)、肝胃阴虚证(5.0%)、气滞痰凝证(9.0%)等。回归分析显示轻症酒精性肝病与气虚气滞证显著相关(P=0.007 0.01);酒精性肝炎与湿热内蕴证(P=0.0000.01)、肝胃气滞证(P=0.0160.05)、痰湿瘀滞证(P=0.0180.05)、脾虚气滞证(P=0.026 0.05)显著相关;酒精性肝硬化与肝胆湿热证显著相关(P=0.01);酒精性脂肪肝优势相关证型不明显(P0.05)。结论:以因子分析方法等数据挖掘技术所获得的证候分布,能够客观阐释中医证候分布特点,比较适用于中医证候的研究。     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.