健脾活血方治疗慢性萎缩性胃炎气虚血瘀型30例

[目的]观察健脾活血方治疗慢性萎缩性胃炎（CAG）气虚血瘀型患者的临床疗效.[方法]60例CAG患者随机分为2组,各30例,对照组予西药常规治疗,治疗组在此基础上加服健脾活血方治疗,8周后,比较2组治疗前后临床症状、胃镜及病理变化.[结果]治疗组总有效率为96.67％,对照组总有效率83.33％,治疗组总有效率及治愈率均优于对照组（P＜0.05）.[结论]健脾活血方治疗CAG能显著改善患者症状、胃镜病理改变,对病情进展起到阻断作用.     

自拟健脾清热化瘀汤治疗溃疡性结肠炎45例

[目的]观察自拟健脾清热化瘀汤治疗溃疡性结肠炎(UC)的临床疗效.[方法]选取90例UC患者,随机分为2组,治疗组45例给予自拟健脾清热化瘀汤口服并灌肠,对照组45例给予柳氮磺吡啶口服,6周后观察2组临床、内镜下治疗效果.[结果]治疗组临床总有效率为93.3％,明显优于对照组的73.3％ (P＜0.05).治疗后治疗组肠镜下黏膜评分0.32±0.84,明显优于对照组肠镜下黏膜评分0.95±0.93(P＜0.05).治疗后随访3个月和6个月,治疗组复发率明显低于对照组.[结论]自拟健脾清热化瘀汤治疗UC疗效显著,复发率低.     

益气健脾汤治疗慢性萎缩性胃炎33例

[目的]观察益气健脾汤治疗慢性萎缩性胃炎（CAG）的临床疗效。[方法]54例CAG随机分为两组，治疗组33例用自拟益气健脾汤治疗，对照组21例用三九胃泰冲剂治疗，均连续治疗3个疗程。[结果]治疗组临床症状总有效率为93．9％，胃镜及病理总有效率为66．7％；对照组临床症状总有效率为66．7％，胃镜及病理总有效率为38．0％，组问疗效比较差异有统计学意义（P〈0．05）。[结论]益气健脾汤疗效明显优于三九胃泰冲剂。     

健脾清肠方治疗脾虚湿热型溃疡性结肠炎的临床观察

[目的]观察健脾清肠方治疗轻、中度脾虚湿热型溃疡性结肠炎的临床疗效。[方法]选取溃疡性结肠炎患者80例,辨证属于脾虚湿热型,采用随机数字表法分为2组,分别是试验组和对照组,每组各40例。试验组口服健脾清肠方,对照组口服美沙拉嗪。疗程为8周。分别观察2组治疗前后肠道症状评分、中医证候积分以及2组中医证候疗效。[结果]2组治疗后腹泻、脓血便、腹痛及里急后重等肠道症状评分与治疗前比较均明显降低(P0.05),其中腹泻与脓血便症状评分试验组显著低于对照组(P0.05)。2组治疗后中医证候评分与治疗前比较均明显降低(P0.05),试验组显著低于对照组(P0.05)。试验组中医证候疗效总有效率为92.5%,对照组为85%。2组比较差异无统计学意义。[结论]与对照组比较,健脾清肠方治疗轻、中度脾虚湿热型溃疡性结肠炎患者具有明显疗效,可以有效减轻和缓解患者肠道症状,减少中医证候积分,具有良好的临床疗效。     

结肠止泻方联合康复新液灌肠治疗溃疡性结肠炎临床观察

[目的]观察结肠止泻方联合康复新液灌肠治疗溃疡性结肠炎的临床疗效。[方法]65例溃疡性结肠炎患者随机分为对照组和治疗组。对照组32例,给予结肠止泻方口服,治疗组33例给予结肠止泻方口服的同时给予康复新液保留灌肠。比较两组的治疗效果。[结果]所有患者完成治疗,未出现不良反应,治疗结果总有效率治疗组90.90%,对照组78.78%。[结论]结肠止泻方配合康复新液灌肠治疗溃疡性结肠炎可以明显提高临床疗效。     

康复新液灌肠联合美沙拉嗪治疗溃疡性结肠炎疗效观察

[目的]探讨康复新液灌肠联合美沙拉嗪治疗溃疡性结肠炎（UC）的疗效。[方法]132例轻中度UC患者,随机分成2组,治疗组66例,给予康复新液100ml,1次／d,灌肠;美沙拉嗪1g,3次／d,口服。对照组66例,给予美沙拉嗪1g,3次／d,口服。2组均予益生菌辅助治疗。于治疗8周后观察2组症状的缓解情况,同时复查电子结肠镜观察治疗效果。[结果]8周后临床症状：治疗组完全缓解率63．64％,总有效率为95．45％;对照组完全缓解率48．48％,总有效率为83．33％;2组比较差异有统计学意义（P〈0．05）。电子结肠镜：治疗组完全缓解率63．64％,总有效率为96．97％;对照组完全缓解率46．97％,总有效率为81．82％;2组比较差异有统计学意义（P〈0．05）。[结论]康复新液灌肠联合美沙拉嗪治疗UC临床疗效较好。     

中药疏肝健脾止痢方联合5-氨基水杨酸治疗慢性溃疡性结肠炎的临床疗效及其对血清TNF-α水平的影响

[目的]探讨中药疏肝健脾止痢方联合5-氨基水杨酸治疗慢性溃疡性结肠炎的临床疗效。[方法]选择110例慢性溃疡性结肠炎患者,随机分为治疗组和对照组。2组除给予相同的营养支持、饮食治疗及局部灌肠用药外,对照组给予5-氨基水杨酸,治疗组则在对照组基础上加用疏肝健脾止痢方,2组均治疗20d,随访2个月。观察临床症状改变以及治疗前后2组血清中TNF-α水平变化。[结果]治疗组总有效率高于对照组,改善情况明显优于对照组,表现为腹痛、腹泻、黏液脓血便症状好转或消失。治疗组治疗后TNF-α水平较对照组降低更显著(P<0.05)。[结论]中药疏肝健脾止痢方联合5-氨基水杨酸治疗慢性溃疡性结肠炎的临床疗效肯定,同时,疏肝健脾止痢方有助于降低患者血清TNF-α水平。     

从结肠黏膜超微结构变化及Claudin-2、5表达探讨健脾清热活血方干预溃疡性结肠炎的临床研究

[目的]从治疗前后中医症状、Claudin-2、5表达水平及黏膜超微结构变化,探讨健脾清热活血方干预溃疡性结肠炎(UC)的作用机制。[方法]选取临床符合纳入标准的50例UC患者,随机分为治疗组和对照组,每组各25例,分别给予健脾清热活血方和美沙拉嗪治疗,疗程为12周。应用结肠镜复查及组织病理学技术比较治疗前后结肠黏膜组织学Geboes评分;应用免疫组化检测结肠黏膜Claudin-2和Claudin-5表达;应用透射电镜检测结肠黏膜超微结构改变;记录治疗前及治疗后4、8、12周中医证状积分,主客观指标合参评估健脾清热活血方的临床效用。[结果]从总体疗效分析,治疗组(80.0%)和对照组(76.0%)对比差异无统计学意义。从主要效应指标分析,治疗后,2组患者肠镜评分、肠黏膜组织学评分较治疗前显著降低(P<0.05),但组间比较差异无统计学意义(P>0.05)。从次要效应指标分析,治疗前2组患者中医症状积分比较差异无统计学意义;治疗后12周综合症状积分较治疗前明显降低(P<0.05);治疗后4周及8周症状积分虽有下降,与治疗前比较差异无统计学意义(P>0.05)。治疗后Claudin-2表达比治疗前显著下调;Claudin-5表达比治疗前显著上调(P<0.05)。电镜下治疗前上皮细胞微绒毛稀疏、变短,细胞间连接松散间隙增宽;治疗后上皮细胞微绒毛排列整齐结构基本完整,细胞间相互连接紧密。[结论]健脾清热活血方可能通过下调Claudin-2、上调Claudin-5表达,修复肠黏膜机械屏障,诱导肠黏膜炎症缓解,从而发挥治疗效用。     

清化湿热为主治疗湿热型溃疡性结肠炎的临床研究

[目的]用清化肠饮方口服配合灌肠I号方灌肠治疗湿热型溃疡性结肠炎（UC）,探索湿热型UC有效的临床疗法及方药。[方法]363例作为研究对象,随机分为2组,对照组30例用巴柳氮钠口服加灌肠,治疗组33例用清化肠饮方口服配合灌肠I号方灌肠。[结果]治疗组总体疗效优于对照组（P〈0．05）,其中完全缓解率为33．33％、总有效率93．94％;对照组分别为20．00％及83．33％。[结论]口服清化肠饮方配合灌肠I号方灌肠治疗湿热型UC与巴柳氮钠口服加灌肠相比,疗效更好,且临床使用安全、不良反应少。     

健脾清肠方联合清肠栓对脾虚湿热证型溃疡性结肠炎患者生存质量的影响

[目的]探讨健脾清肠方联合清肠栓对脾虚湿热证型溃疡性结肠炎患者生存质量的影响。[方法]选取脾虚湿热证型溃疡性结肠炎患者53例,随机数字表法随机分配为试验组（28例）与对照组（25例）;试验组、对照组分别予以健脾清肠方联合清肠栓、5-氨基水杨酸联合清肠栓治疗;治疗8周后,评价2组患者炎症性肠病生存质量问卷（IBDQ）、健康调查简表（SF-36）计分以及证候与症状疗效。[结果]试验组和对照组IBDQ积分分别提高19．3、9．0,SF-36积分分别提高11．1、6．0。2组之间SF-36躯体疼痛维度差异有统计学意义（P〈O．05）。试验组与对照组的证候疗效判定差异无统计学意义（P〉O．05）;单项症状疗效判定中2组仅“乏力”一项差异有统计学意义（P〈0．05）。[结论]健脾清肠方联合清肠栓的内外合治法能有效改善脾虚湿热证型溃疡性结肠炎患者的生存质量。     

Towards classification criteria for early-stage knee osteoarthritis: A population-based study to enrich for progressors

ObjectiveTo facilitate a greater likelihood of favorable response to new disease-modifying therapies, recruitment of patients at an earlier stage of their disease into clinical trials may be an attractive strategy. Hence, there is a need to develop widely accepted classification criteria for early-stage knee osteoarthritis (OA). We have proposed a set of classification criteria for early-stage knee OA (2018 classification criteria) now being further refined. Here, we test the draft criteria for enrichment for clinical and structural progression.DesignPerformance of the 2018 classification criteria for early stage knee OA was tested using data from the Osteoarthritis Initiative (OAI). The OAI comprises data of 4796 men and women aged 45–79 years with or at risk for knee OA at baseline. Based on the 2018 classification criteria, a knee with Kellgren & Lawrence (K&L) grade of 0-I, two out of four Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales equal or less than 85, and presence of at least one of joint line tenderness or crepitus, was considered as early-stage knee OA. Knees with K&L grade 0-I that did not fulfill the 2018 criteria, were considered as controls. Logistic regression analysis was used to evaluate the predictive performance of the criteria set for structural as well as clinical progression. We further explored the discriminatory capability of criteria by including the average KOOS₄ score, and relevant clinical examination findings such as the presence of effusion and/or Heberden's nodes.ResultsWe identified 1315 (27%) knees from OAI fulfilling the 2018 early-stage knee OA classification criteria. The female to male ratio was higher in the early knee OA group compared to controls. The early-stage knee OA group were on average slightly younger and had higher body mass index vs controls (mean [SD] age: 59.2 [8.9] years vs. 60.2 [9.1] and mean [SD] BMI 28.3 [7.0] vs. 26.8 [6.0]). By applying the 2018 criteria, there was a substantial enrichment compared to controls at 48 and 96 months for both structural (OR=1.1–1.4, and AUC=0.72–0.74) and clinical progressors (OR=2.1–2.5, 95% and AUC=0.66). Expanding the clinical examination findings by including joint effusion and/or Heberden's nodes improved the enrichment for both structural and clinical progressors (OR=4.2, 95% confidence interval=3.2–5.5 and OR=3.3, 95% confidence interval=2.8–3.5, respectively). Replacing scoring of the 4 separate KOOS domains by a KOOS₄ score performed comparably.ConclusionsThe proposed 2018 early-stage knee OA classification criteria showed encouraging performance characteristics with regard to an enrichment for structural and clinical progression using longitudinal OAI data. Our results indicate that the addition of clinical findings improves the performance of previous criteria to define early-stage disease and risk for progression.     

欣胃颗粒治疗气阴两虚挟瘀挟毒型胃癌前病变的临床观察

[目的]评价欣胃颗粒治疗气阴两虚挟瘀挟毒型胃癌前病变（GPL）的有效性。[方法]选择中医辨证属气阴两虚挟瘀挟毒型GPL患者60例,随机分为2组：欣胃颗粒治疗组（治疗组）30例;胃复春治疗组（对照组）30例;均治疗3个月,观察2组临床、胃镜、病理疗效及胃泌素（GAS）、生长抑素（ss）的变化。[结果]治疗组的临床、胃镜、病理疗效以及GAS,SS水平结果均显著优于对照组（P〈0.05）。[结论]欣胃颗粒对GPL有良好的疗效。     

Inclusion criteria for clinical trials in sepsis: did the American College of Chest Physicians/Society of Critical Care Medicine consensus conference definitions of sepsis have an impact?

BACKGROUND: Over the last 25 years, a growing number of clinical trials have evaluated novel sepsis therapies. To promote uniformity in inclusion criteria for patient enrollment, the American College of Chest Physicians and Society of Critical Care Medicine first published consensus conference definitions for sepsis in 1992. STUDY OBJECTIVES: To characterize (1) the utilization of specific criteria for patient enrollment in sepsis clinical trials and (2) the impact that the consensus conference definitions have had on these criteria. DESIGN: We used MEDLINE to identify clinical trials in sepsis from 1976 to 2001. Clinical trials published after the consensus conference (ACC; from 1993 to 2001) were compared with trials published before the consensus conference (BCC; from 1976 to 1992). RESULTS: We identified 176 clinical trials (ACC, 119 trials; BCC, 57 trials). Clinical trials published ACC were more likely to utilize or reference a previously published standard for inclusion criteria (65% vs 11%, respectively; p < 0.001). The consensus conference definitions were the standards used in 69% of these trials. The utilization of specified values for WBC count, temperature (T), heart rate (HR), and respiratory rate (RR) was significantly increased in the ACC group compared to the BCC group, as follows: WBC count, 62% vs 26%, respectively (p < 0.001); T, 89% vs 56%, respectively (p < 0.001); HR, 77% vs 26%, respectively (p < 0.001); and RR, respectively 76% vs 28% (p < 0.001). ACC, clinical trials were less likely to require blood culture positivity (4 of 119 trials [3%] vs 9 of 57 trials [16%], respectively; p < 0.006) and were more likely to incorporate markers of acute organ dysfunction (81 of 119 trials [68%] vs 28 of 57 trials [49%], respectively; p < 0.03) in the inclusion criteria. CONCLUSIONS: (1) Since 1992 there has been a significant increase in the utilization of predefined sepsis criteria for patient enrollment in clinical trials, and this increase can be attributed to the existence of consensus conference definitions. (2) Compared to inclusion criteria BCC, inclusion criteria ACC were less reliant on blood culture positivity and were more likely to incorporate markers of organ dysfunction.     

The applicability of the Asian modified criteria of the metabolic syndrome in the Korean population

BackgroundWe compared the metabolic profiles and risk of coronary artery disease (CAD) in Koreans with non-diabetic metabolic syndrome (MetS). [We applied four criteria of MetS: the NCEP criteria, the Asian modified NCEP (a-NCEP) criteria, the WHO criteria and the Asian modified WHO (a-WHO).]MethodsThe study group composed of 2724 subjects enrolled in the cardiovascular genome center. There were 728 patients with significant CAD. The different criteria of the MetS were applied for the study population.ResultsAmong the 2724 participants, 522 (19.2%) met the NCEP criteria, 796 (29.2%) met the a-NCEP criteria, 361 (13.3%) met the WHO criteria and 576 (21.1%) met the a-WHO criteria. The clinical parameters, lipid profile, apoA1 and apoB level were not different between the participants classified as MetS by using the different criteria. The odds ratio for CAD prediction were not significantly different according to the metabolic criteria (odd ratio: 1.755 [95% CI: 1.423–2.163] in NCEP criteria, 2.120 [1.763–2.549] in a-NCEP criteria, 1.854 [1.466–2.343] in WHO criteria, 2.205 [1.810–2.687] in a-WHO criteria). The serum level of apoA1 and apoB showed strong correlations with MetS classified by all criteria and the HOMA index and insulin level showed better correlations with WHO-MetS criteria.ConclusionsAll the MetS criteria showed similar metabolic profiles and all four criteria had similar predictive value for CAD. Conventional MetS criteria, applied to the non-diabetic Asian population, may underestimate the population at risk. Our data suggests that the Asian modified criteria will decrease the risk for underdiagnosis while demonstrating similar metabolic profiles and CAD risk compared to the conventional criteria.     

Inclusion criteria as widely used for rheumatoid arthritis clinical trials: patient eligibility in a Turkish cohort

OBJECTIVE: To identify the proportion of patients fulfilling the inclusion criteria widely used in most clinical trials for rheumatoid arthritis (RA)--including the recent clinical trials of anti-Tumor Necrosis Factor alpha (TNFalpha) agents--in a Turkish cohort. METHODS: 186 consecutive RA patients attending a routine tertiary rheumatology clinic were evaluated in 2 groups: Early RA group (group E): 31 patients with a disease duration of < or = 3 years (mean: 1.9 +/- 0.9 years); late RA group (group L): 155 patients with a disease duration of > 3 years (mean: 13.3 +/- 8.6 years). Patients were evaluated according to 2 different sets of inclusion criteria: (i) The widely used common inclusion criteria for RA clinical studies, as outlined by Sokka and Pincus; (ii) the criteria of two major anti-TNF clinical studies, ERA and ATTRACT. RESULTS: No patients in group E, and 9 (6%) patients in group L fulfilled the common criteria used in clinical studies for RA. In group E, 28 patients had already been started on methotrexate; 2 patients were on sulphasalazine and one patient was on leflunomide. Nevertheless, even if the criterion for previous use of methotrexate was not applied patients did not fulfill the rest of the criteria of ERA study. In group L, 9 out of 155 patients (6%) met the criteria for the ATTRACT study. CONCLUSION: Only few patients met the widely used inclusion criteria for most RA clinical trials and the recent clinical trials of TNFalpha agents in this Turkish cohort. This may be explained by the milder disease activity in this geographical region, which further emphasizes the need to consider development of new criteria for inclusion in clinical trials.     

Validation of American College of Rheumatology classification criteria for knee osteoarthritis using arthroscopically defined cartilage damage scores

OBJECTIVE: To validate the ability of the American College of Rheumatology (ACR) clinical classification criteria and the ACR clinical plus radiographic classification criteria for osteoarthritis of the knee to predict articular cartilage damage. METHODS: Ninety subjects with knee osteoarthritis (OA) who were enrolled in a prospective study determining the therapeutic efficacy of arthroscopic irrigation were characterized as to whether they fulfilled the ACR clinical classification criteria or the ACR clinical plus radiographic classification criteria. Ten rheumatoid arthritis (RA) patients were included as controls. Cartilage damage was defined using the ACR/Knee Arthroscopy Osteoarthritis Scale (ACR/KAOS) system, which is a validated outcome instrument for knee OA based on arthroscopic visualization. Mean values of the damage scores in each group were calculated and compared by t-test to determine statistical significance between the 3 groups. RESULTS: The mean ACR/KAOS score for the 10 RA patients was 1.8 [SD 1.22; range 0 to 4]. Of the 90 OA patients who underwent arthroscopy, only 73 patients had sufficient videotape to make an accurate assessment by the blinded assessor. The mean ACR/KAOS score for the 6 OA patients who fulfilled only the ACR clinical classification was 17.4 [SD 11.3; range 5 to 34.3] and the mean ACR/KAOS score for the 67 patients who fulfilled the ACR clinical plus radiographic classification criteria was 42.0 [SD 29.1; range 5.1 to 118.4]. These differences were statistically significant (RA versus OA clinical P=0.02; RA versus OA clinical+radiographic P相似文献   

大剂量赤芍治疗重症急性胰腺炎疗效观察

[目的]探讨大剂量赤芍治疗早期重症急性胰腺炎(SAP)的临床疗效。[方法]将符合SAP诊断标准的52例患者随机分成2组,对照组24例应用常规西医治疗方法(包括:加强监护、禁食、胃肠减压、生长抑素、抗感染等);治疗组28例在常规治疗的基础上应用大剂量赤芍煎剂,予胃管内注入。观察2组腹痛、发热、恶心呕吐症状消失的时间,血淀粉酶、白细胞、血钙、血糖恢复正常的时间及并发症的发生率。[结果]治疗组腹痛、发热、恶心呕吐症状消失时间及血淀粉酶、白细胞、血糖恢复正常时间均快于对照组(均P<0.05);2组血钙恢复正常时间比较,差异无统计学意义(P>0.05);治疗组并发症的发生率低于对照组(P<0.05)。[结论]早期应用大剂量赤芍治疗SAP,可尽快改善患者的症状和实验室指标,明显减少并发症的发生。     

奥曲肽治疗血吸虫肝硬化上消化道出血的临床评价

[目的]探讨奥曲肽治疗血吸虫肝硬化上消化道出血的临床诊治特点和治疗效果。[方法]选择我院2011年4月~2014年1月收治的符合此次研究纳入标准的血吸虫肝硬化上消化道出血患者50例作为研究对象,按照随机对照原则,将患者随机分为对照组和实验组。实验组接受奥曲肽治疗,对照组进行垂体后叶素治疗,比较2组患者的临床疗效以及不良反应发生率等。[结果]实验组和对照组患者接受治疗后,实验组治疗总有效率为92.0%,对照组患者治疗总有效率为64.0%,2组比较差异有统计学意义（P〈0.01）;实验组患者的平均止血时间、再出血率以及并发症发生率均低于对照组,2组比较差异有统计学意义（P〈0.05）。[结论]奥曲肽在治疗血吸虫肝硬化上消化道出血方面较传统方法（垂体后叶素）临床效果显著,不良反应少,改善了患者的预后,提高了患者的生存质量,故该治疗方法值得在临床上进一步推广应用。     

肠愈宁治疗活动期溃疡性结肠炎疗效观察

[目的]观察肠愈宁颗粒治疗活动期溃疡性结肠炎(UC)的临床疗效.[方法]60例患者随机分为2组各30例,治疗组予以中药肠愈宁颗粒口服,10g,早晚分服;对照组予口服美沙拉嗪1.0 g/次,4次/d.8周为1个疗程.观察2组患者治疗后主要临床症状、结肠镜下黏膜改善情况及临床疗效.[结果]治疗组总有效率为93.3％,对照组90.0％,2组比较差异无统计学意义(P＞0.05).临床症状改善情况2组比较差异亦无统计学意义(P＞0.05).[结论]肠愈宁颗粒治疗活动期UC疗效显著,与西药美沙拉嗪相当,值得临床推广应用.     

Clinical evaluation and comparison of different criteria for classification in Turkish patients with psoriatic arthritis

Several criteria are being used for the classification of psoriatic arthritis (PsA) and there is a lack of consensus about PsA as a separate entity. Our aim is to investigate the clinical features of our patients with a clinical diagnosis of PsA, compare the sensitivities of different classification criteria, agreement between the criteria. In this study 86 PsA patients were investigated (48 females, mean age 44). Moll and Wright criteria was fulfilled by 91%, Vasey and Espinoza criteria by 94% and modified European SpA study group criteria by 59%, classification of PsA study group criteria by 86%, modified McGonagle criteria by 96%, Fournie et al. criteria by 84% and Gladman criteria by 95%. Significant agreement was present between criteria but generally κ-values were less than 0.5. The pattern of PsA can differ with time and the implementation of the available classification criteria showed considerable differences.