介入治疗肝癌对免疫功能影响的研究进展

肝癌是我国常见的恶性肿瘤之一,因其恶性程度高,易于复发和转移而被广泛关注.肝癌的发生、发展及预后与机体的免疫功能密切相关,肝癌患者一般免疫功能低下,这也是肝癌复发和转移的重要因素.目前,肝癌的治疗多是以外科切除为基础的综合治疗,但患者就诊时多属于中晚期,错过了外科手术机会.肝癌的介入治疗被认为是非外科治疗的首选方法.介入治疗在破坏肿瘤组织的同时,也促进了肿瘤细胞的凋亡,特别是提高了细胞免疫功能,增强机体抗肿瘤的免疫力,免疫功能的提高可能起到抑制肿瘤复发和转移的作用.本文就近年来国内外介入治疗对患者免疫功能的影响作一综述.     

营养支持在胃肠肿瘤综合治疗中的定位与发展

消化系统空腔脏器的恶性肿瘤除肿瘤炎性反应干扰营养代谢外,直接导致进食障碍、消化不良、吸收不足等,因此患者营养不良(本文主要指营养不足,下同)尤为多见,不仅发生率高、对机体危害大,对各类抗肿瘤治疗的影响也最为严重。随着营养肿瘤学理念的建立,以及肿瘤多学科综合治疗的规范和普及,营养支持在胃肠肿瘤综合治疗中的价值日益彰显,临床及基础研究活跃,本文结合临床实践,概述如下。营养不良在胃肠肿瘤的发生     

肝细胞癌切除术后复发的原因与防治策略

肝细胞癌(hepatocellular carcinoma, HCC)是临床上常见的恶性肿瘤之一,HCC切除术后3年复发率约为50%,5年复发率超过70%,居高不下的高复发率严重影响HCC患者手术疗效和长期生存,是导致HCC患者术后死亡的首要原因. HCC术后复发是一个多步骤、多环节、多因素和多分子参与的复杂过程,涉及机体、微环境和肿瘤组织三个方面因素,包括机体免疫力、局部p H值、间质压力、血管渗透压、炎性反应、肿瘤细胞黏附、细胞外基质降解、细胞迁移、细胞增殖和肿瘤血管形成等,与多个基因表达异常和相关分子功能改变密切相关,但HCC术后复发的分子机制仍未完全阐明,需要更深入的研究.HCC术后复发如何治疗直接影响HCC患者预后,涉及再次手术、肝移植、局部微创治疗、放疗、分子靶向药物、免疫和中医药治疗,单一治疗方法难以达到治愈或控制肿瘤进展,需要两种或两种以上治疗方法有机地联合,达到协同增效的治疗效果.针对患者的具体情况,分析其个体特性,结合临床医生的临床经验和最佳证据,采取个体化的治疗方案,选择合适的治疗方法是提高疗效的关键.对于存在高危复发因素的HCC患者,术后选择适当的治疗方法预防HCC复发,是降低HCC术后复发率,延长患者生存期的重要措施,才能使术后HCC患者最大程度获益.     

冻干治疗用母牛分枝杆菌菌苗与滋阴利肺汤佐治老年肺结核患者疗效及其机制

老年人肺结核由于患者抵抗力低且患病时间长,常易发生耐药性,并已经形成了一种感染-耐药-复发-再传染的恶性循环。中医药治疗结核具有提高抗菌效果,增强机体免疫功能、改善患者中毒症状,缩短疗程作用。有研究显示结核发生发展中,血清中可出现炎性因子改变,尤其以肿瘤坏死因子(TNF)-     

同期治疗肺结核与肺癌并存患者的护理

目的为了使肺结核与肺癌并存患者在抗结核治疗同时能顺利完成放化疗，控制肿瘤的进展，防止结核播散，延长生存期。方法对33例肺结核与肺癌并存病人在抗结核治疗同时予放、化疗，在治疗前后加强支持治疗和免疫治疗，并注重细心观察和精心护理。结果除1例WBC〈0.5×10^9／L，放疗40Gy／20次后，放弃治疗，15例患者在抗结核治疗同时完成了放疗，17例患者完成了2～4疗程的化疗。结论对33例肺结核与肺癌并存病人在抗结核及放化疗同期治疗中实施精心护理可增强机体的抵抗力和免疫力，提高放化疗反应的耐受性，使本组32例患者顺利完成治疗，无1例导致结核进展和播散。     

肾移植术后发生原泌尿系肿瘤5例临床分析

肾移植术是目前治疗终末期肾病的主要方法,其有效性已得到临床广泛认可,人肾存活率明显提高.但因肾移植术后患者大量应用免疫抑制剂,故导致其机体免疫力下降,自身肿瘤发病率升高.2005 ～ 2013年,我院对136例患者施行肾移植术治疗,其中术后发生原泌尿系肿瘤5例（3.7％）.现报告如下.     

早期肠内营养支持对重型脑卒中患者营养状况和免疫功能的影响

目的 探讨早期肠内营养用于重型脑卒中患者的效果.方法 将100例重型脑卒中患者随机分为观察组和对照组各50例,分别予早期肠内营养支持和胃肠外营养+普通流质饮食,疗程均为3周.治疗前后测定两组营养状况和免疫功能指标,同时观察感染性并发症发生率.结果 治疗3周后观察组Hb和血清白蛋白水平显著高于对照组, CD+8水平显著低于对照组, CD+3、CD+4和CD+4/ CD+8显著高于对照组,感染性并发症发生率显著低于对照组(P均＜0.05).结论 对重症脑卒中患者行早期合理的肠道营养支持可改善机体营养状况,增强机体免疫力,预防或减少各种并发症发生.     

肠内营养对重症急性胰腺炎患者免疫功能影响的研究进展

重症急性胰腺炎(severe acute pancreatitis,SAP)是临床常见的急危重症,病死率高,其发生、发展和转归与机体免疫功能失衡密切相关.SAP患者免疫功能失衡,表现为早期免疫过激及后期的免疫抑制.肠内营养不仅能提供机体代谢所必须的营养要素,而且可以从肠道免疫、全身免疫、体液免疫及细胞免疫等方面调节机体的免疫功能,成为SAP综合治疗的重要组成部分.本文就肠内营养对SAP机体免疫功能的影响及最新研究成果进行综述.     

中医药在调节胃肠道菌群以防治胃肠道肿瘤中的作用和意义

近年的研究显示:胃肠道微生态与胃肠道恶性肿瘤的发生发展及抗肿瘤治疗密切相关.有效调节胃肠道微生态对防治胃肠道肿瘤具有重要作用.中医药多采用口服进药方式,可以直接发挥调节胃肠道微生态作用,通过改善胃肠道微生态结构、保护胃肠道黏膜屏障、防止菌群移位、增强胃肠黏膜免疫功能等多途径对胃肠道恶性肿瘤起到干预作用,其中在改善癌前状态及联合抗肿瘤治疗提高临床疗效等方面可以发挥重要作用.现代研究显示:胃肠道微生态与脾虚证、湿热证关系密切,中医药可以健脾和胃、清热祛湿为治则,遵循"病证结合"的诊疗思维,通过调节肠道微生态新视角防治胃肠道肿瘤具有重要意义,希冀为中医药抗肿瘤研究提供新策略.     

重视老年疾病的免疫指标

机体的免疫状态随年龄的增长而变化,免疫防御、免疫监视和自身稳定功能总体趋于降低,可表现为对抗感染的能力减弱、肿瘤和自身免疫性疾病的多发等.这归咎于免疫应答的物质基础--免疫系统的衰老,以及因此导致的免疫应答调节异常.延年益寿的主观愿望需要与增强体质、提高免疫功能的自觉行动相伴.有理由相信,寿命是可塑的,可以借助有益于机体免疫力提高的健康行为和对相关免疫指标的关注,达到增强防病抗病能力之效果,实现延年益寿之目的.     

降气和胃通腑法对肠癌患者术后胃肠功能及免疫功能的影响

目的:观察针灸和中药恢复肠癌术后患者胃肠功能和免疫功能的临床疗效.方法:将肠癌根治性手术后的105例患者随机分成对照组、中药组和针灸组,各35例.对照组给予术后常规处理;中药组给予术后常规处理和术后第1天营养管推入四磨汤口服液20mL,每日3次,治疗10 d;针灸组给予术后常规处理和术后第1天针灸治疗,每日1次,治疗1...     

中医药治疗食管癌的研究进展

为了总结中医药治疗食管癌的相关研究及发展状况,为食管癌的治疗寻求新的研究方法与治疗思路,查阅近10 a相关文献,并从理论认识、临床和实验研究等方面进行综述。发现近年来中医药在食管癌病因病机、证候、治则治法等理论认识方面都取得了一定进展;临床上中医药在食管癌围手术期可进行辅助治疗,与化疗药或放疗联合治疗可以起到增效减毒、提高患者生存质量、提高机体免疫力的作用;在实验方面,中医药对食管癌细胞有抑制增殖、诱导凋亡及降低其侵袭能力、调节机体免疫能力等作用,涉及多个分子和细胞信号传导通路。     

原发性肝癌中西医结合介入诊疗专家共识(试行第一版)

本共识由国家中医药管理局重大疑难疾病-中西医临床协作项目-肝癌项目组牵头撰写,该项目建立了早期肝癌微创根治性消融和中晚期肝癌TAE/TACE序贯微创介入消融,联合中医辨证整体施治,形成了介入栓塞标记肿瘤,序贯微创局部消融及解剖模式消融术,去除影像学可见肿瘤,建立了以肝段消融术为代表的肝脏消融体系;应用中医扶正去邪提升机体免疫功能,重塑不适合肿瘤生长的微环境,去除影像学不可见的微小肿瘤,探索出了“中西医结合临床协作治疗肝癌”的整体解决方案。本共识以中医药微环境调理和微创消融相结合为特色,充分发挥中医扶正、辨证施治的整体治疗优势与微创消融精准灭活肿瘤,同时保留正常解剖结构、生理功能和免疫功能的局部治疗特点,采用整体治疗与局部消融治疗相结合,中医药调理与微创消融相结合,开创了肝癌中西医结合微创诊疗新模式。该共识的实施使BCLC A期肝癌达到了与开放性手术相同的根治性治疗效果,使以往开放式手术不能治疗的BCLC B/C期肝癌也获得了根治性效果,使肝癌治疗进入到人文化诊疗新模式,是卫生经济学效应最大化实施方案。     

Palliative Care and End-of-Life Issues in Patients Treated with Left Ventricular Assist Devices as Destination Therapy

Left ventricular assist devices as destination therapy (DT) improve quality of life for many patients with advanced heart failure. However, DT can be associated with risks such as infection, bleeding, and stroke, and may impose psychosocial strain on patients and caregivers. Furthermore, patients treated with DT eventually will die with their device in place whether death is related to the device or not. In response to these concerns, palliative medicine consultation has been suggested with standard DT care to improve focus on quality of life, symptom management, and end-of-life planning. This article reviews key issues associated with caring for patients with DT, including psychosocial, quality-of-life, caregiving, and ethical issues, and discusses end-of-life management of patients with DT, including practical considerations, but moreover, review topics regarding communication, symptom management, and provision of appropriate comfort care.     

中西医结合治疗乙型肝炎策略的重心仍应在调节免疫

笔者比较中医学“正气”理论及西医学“免疫”理论,分析在外邪入侵导致的疾病中,中医学特别注重“正气”的理由;深入剖析现代西方医学对于乙型肝炎的认识思想,指出抗病毒治疗的缺陷和调节免疫治疗的重要性;得出中西医结合治疗乙型肝炎的发展方向应当以调节免疫为主的结论。     

中医药治疗干预老年Ⅳ期胃癌患者生活质量的效果分析

目的研究中医药综合治疗对提高老年Ⅳ期胃癌患者生存质量改善作用。方法对61例确诊为Ⅳ期胃癌、条件不允许接受放、化疗的老年患者按照随机原则分为中医药综合治疗组和单纯对症支持治疗组，其中31例接受中医综合治疗，30例接受对症和一般支持治疗，治疗结束后观察其呕吐情况、食欲改善、癌痛控制情况，并对2组患者KPS评分和生存质量评分提高程度进行统计分析。结果中医综合治疗组的患者进食量改善、癌痛缓解、呕吐减轻，疗效明显优于对照组。结论老年Ⅳ期胃癌患者积极进行中医综合治疗可以较全面地改善其生活质量。     

Treatment of irritable bowel syndrome in China:A review

Irritable bowel syndrome(IBS)is a common,chronic,functional gastrointestinal disorder with a high incidence rate in the general population,and it is common among the Chinese population.The pathophysiology,etiology and pathogenesis of IBS are poorly understood,with no evidence of inflammatory,anatomic,metabolic,or neoplastic factors to explain the symptoms.Treatment approaches are mainly focused on symptommanagement to maintain everyday functioning and to improve quality of life for patients with IBS.However,prescribed medications often result in significant side effects,and many IBS sufferers(particularly Chinese)do not improve.Instead of taking a variety of conventional medications,many have turned to taking traditional Chinese medicine or integrated Chinese and Western medicine for remedy.A number of clinical trials have shown that Chinese herbal,acupuncture or integrative therapies presented improved treatment outcomes and reduced side effects in IBS patients.The purpose of this review article is to examine the treatment approaches of IBS that have been published in recent years,especially in China,to assess the possible differences in treating IBS between China and other countries.This would provide some useful information of unique treatment approach in clinical practice for physicians in the management of IBS in China,thus offering more treatment options for IBS patients with potentially better treatment outcomes while reducing the medical cost burden.     

Different Chinese herbal medicine therapy for idiopathic thrombocytopenic purpura: A protocol for systematic review and Bayesian network meta-analysis

Background:Idiopathic thrombocytopenic purpura (ITP) is a common immune system and blood system disease in clinical practice, and it is a hemorrhagic disease caused by immune factors causing platelet destruction and decreasing number of platelets. There is currently no effective treatment plan for ITP. At this stage, glucocorticoid and gamma globulin are mostly used in the treatment of ITP, and some patients use splenectomy to achieve therapeutic purposes, but the various treatment methods are inadequate. At this stage, a large number of randomized controlled studies have reported that Chinese herbal medicine has achieved good curative effect in the treatment of ITP. However, due to the variety of Chinese herbal medicine, there has been no evidence of the effectiveness and safety of Chinese herbal medicine in the treatment of ITP. Because of the above reasons, this study uses the network meta-analysis method based on Bayesian method to compare the clinical efficacy and safety of different kinds of Chinese herbal medicine in the treatment of ITP through direct and indirect comparison, in order to provide evidence-based medical support for the treatment of ITP with Chinese herbal medicine.Methods:This study uses the method of combining free words with theme words, and using computer to retrieve PubMed, EMbase, The Cochrane Library, WANFANG Database, CNKI, and VIP Database, etc, to collect the randomized control studies on Chinese herbal medicine in the treatment of ITP. The retrieval time is from the establishment of each database to January 2021, and the retrieval languages are Chinese and English. Two researchers independently read the title, abstract and full text of the article to determine whether it is included in the literature; In the event of a disagreement, a third researcher will join the discussion to resolve the disagreement; For the literature that lacks information, trying to contact the original author of the document to supplement it. The literature quality evaluation carried out by using the Stata 14.0 software to draw network and funnel plots, in accordance with the quality evaluation criteria of version 5.1.0 of the Cochrane System Evaluation Manual. Statistical analysis is performed by using ADDIS 1.16.8 software based on the Bayesian model.Results:This study will compare the clinical efficacy and safety of different types of Chinese herbal medicine in the treatment of idiopathic thrombocytopenic purpura through the method of network meta-analysis, and rank the different types of Chinese herbal medicine according to their effectiveness, and the results will be published in a peer-reviewed, high-quality academic journal.Conclusion:This study will find effective and safe Chinese herbal medicine for clinical treatment of ITP from the perspective of evidence-based medicine, and benefit more ITP patients.     

艾灸联合中药药浴治疗糖尿病肾病水肿患者的临床疗效

目的探究艾灸联合中药药浴治疗糖尿病肾病水肿患者的临床疗效。方法研究对象为2017年12月-2018年12月收治的82例糖尿病肾病水肿患者,分为两组,41例给予常规治疗者作为对照组,41例给予艾灸联合中药药浴治疗者作为实验组,对比两组疗效。结果实验组治疗前与治疗后水肿积分对比差异有统计学意义(P<0.05),且治疗后实验组水肿积分显著低于对照组,差异有统计学意义(P<0.05)。实验组治疗总有效率(95.1%)显著高于对照组(78.0%),差异有统计学意义(P<0.05)。结论在糖尿病肾病水肿患者中给予艾灸联合中药药浴治疗,其疗效显著,能够有效地改善患者水肿现象,促使患者生活质量的提高,在临床上的应用价值较高。     

The efficacy and safety of modified Gegenqinlian Fomular for advanced colorectal cancer (damp heat accumulation type): A multicenter randomized controlled trial

Introduction:CRC, the incidence of the fourth highest among males and the third among females, is one of the malignant tumors that seriously threaten human health. The principle of treatment for advanced stage CRC is a multidisciplinary and comprehensive treatment based on chemotherapy, which always bring significant toxic side effects. CHM has advantages in the treatment of tumors with the effect on improving clinical symptoms and reducing side effects. GGQL formula is mainly used for treating abnormal defecates caused by damp-heat, so we will evaluate the clinical efficacy and safety of modified GGQL formula for patients with advanced CRC with the type of damp-heat in this study.Methods:Multicenter RCT with two parallel groups in three hospitals planning to recruit 120 CRC patients with the type of damp-heat will be conducted. The control group will be treated by basic antitumor therapy and the treatment group will use modified GGQL formula plus basic antitumor therapy. The primary outcomes will be quality of life, TCM symptom score, PFS and OS, and the secondary outcomes will be performance status, size of tumor, tumor marker in the serum, tumor microenvironment and immune status. All analyses will be based on an intention-to-treat principle. This study was approved by the Human Research Ethics Committee of Shanxi Province Hospital of Traditional Chinese medicine (2021Y-06017). The results will be published in relevant journal.Discussion:The results of this RCT will contribute to Chinese herbal medicine for treating CRC patients with the type of damp heat accumulation.Trial registration:ChiCTR2100050754 (September 4, 2021).