茵栀黄软胶囊联合拉米夫定治疗慢性乙型肝炎肝胆湿热证临床观察

目的:探讨茵栀黄软胶囊联合拉米夫定治疗慢性乙型肝炎肝胆湿热证的临床疗效。方法:选取我院2013年3月²014年1月收治的慢性乙型肝炎肝胆湿热证患者98例,随机分为观察组和对照组各49例,观察组患者给予中药茵栀黄软胶囊联合西药拉米夫定治疗,对照组患者仅给予西药拉米夫定治疗,比较两组患者治疗1、2、3个月后症状缓解状况、肝功能恢复状况及HBV-DNA转阴率。结果:观察组患者治疗3个月后症状缓解有效率93.88%(46/49),显著高于对照组缓解有效率83.67%(41/49),差异有统计学意义(P<0.05);观察组患者治疗后ALT、AST改善情况及HBV-DNA转阴率均显著优于对照组,差异有统计学意义(P<0.05)。结论:茵栀黄软胶囊联用拉米夫定治疗慢性乙型肝炎肝胆湿热证效果优于单独使用西药拉米夫定,疗效显著,值得临床推广使用。     

加味黄连解毒汤治疗慢性荨麻疹血热证的临床研究

目的:探讨加味黄连解毒汤对慢性荨麻疹血热症患者的临床疗效.方法:选择符合标准的慢性荨麻疹血热症患者108例,根据随机数字表法分为观察组(n=54)和对照组(n=54).对照组予以氯雷他定片治疗,观察组给予加味黄连解毒汤治疗.比较2组患者治疗6个月后疗效、治疗前及治疗6个月后血清免疫因子[白细胞介素-4(IL-4)及干扰素-γ(IFN-γ)及免疫球蛋白E(IgE)]水平及随访半年统计复发情况.结果:与对照组治疗总有效率相比,观察组高,差异有统计学意义(P＜0.05);治疗后,2组IL-4、IgE水平降低,IFN-γ水平升高,观察组IL-4、IgE水平低于对照组,IFN-γ高于对照组,差异有统计学意义(P＜0.05);观察组复发率略低于对照组,差异无统计学意义(P＞0.05).结论:加味黄连解毒汤治疗慢性荨麻疹血热证患者疗效确切,可有效调节免疫血清因子水平,改善临床症状,控制复发率.     

干扰素α-2b联合阿德福韦酯在慢性乙型肝炎患者中的疗效

目的探讨扰素α-2b联合阿德福韦酯在慢性乙型肝炎患者中的临床疗效。方法选取2012年4月至2016年4月该中心收治的慢性乙型肝炎患者140例,采用随机数字表法分为对照组(n=70)和观察组(n=70)。对照组采用干扰素α-2b治疗,观察组在对照组基础上联合阿德福韦酯治疗,采用酶联免疫试验检测两组血清γ干扰素(INF-γ)及白细胞介素(IL)-21水平,比较两组临床疗效及安全性情况。结果观察组治疗后血清INF-γ水平低于对照组,治疗后血清IL-21水平高于对照组,差异均有统计学意义(P0.05);观察组治疗后乙型肝炎e抗原转阴率、乙型肝炎病毒脱氧核糖核酸转阴率、丙氨酸氨基转移酶复常率均高于对照组,差异有统计学意义(P0.05);两组治疗后药物不良反应发生率比较差异无统计学意义(P0.05)。结论慢性乙型肝炎患者在常规治疗基础上联合干扰素α-2b和阿德福韦酯治疗效果理想,值得推广应用。     

慢性乙型肝炎中医证型与HLA-A24、CW1基因及ALT、AST相关性研究

目的:探讨宿主基因HLA-A24、CW1表达、HBV-DNA荧光定量及生化指标ALT、AST变化与慢性乙型肝炎中医临床各证型的相关性.方法:收集符合标准的98例乙型肝炎患者按照中医辨证分型分为肝胆湿热、肝郁脾虚、肝肾阴虚、瘀血阻络及脾肾阳虚5种证型,设40名健康人为正常对照组.实时荧光定量PCR检测血清中的乙肝病毒定量(HBV-DNA)水平及白细胞中的HLA-A24和CW1基因水平,全自动生化分析仪上检测血清中丙氨酸氨基转移酶(ALT)和门冬氨酸氨基转移酶(AST),并分析相关因素与不同中医证型的相关性.结果:HBV-DNA定量检测结果:四组证型之间差异无统计学意义(P＞0.05);HLA-A24定量结果:以脾肾阳虚证型最低,四组证型与正常对照组相比较,结果差异有统计学意义(P＜0.05);HLA-CW1定量结果以肝胆湿热最低,与肝郁脾虚及脾肾阳虚组之间差异有统计学意义(P＜0.05);ALT定量结果以脾肾阳虚证最高,与其它三组(肝郁脾虚、肝肾阴虚及瘀血阻络)结果相比较有统计学意义(P＜0.05);AST定量结果以脾肾阳虚证最高,与其它三组(肝胆湿热、肝肾阴虚及瘀血阻络)结果比较差异有统计学意义P＜0.05).相关性比较:HBV-DNA定量与ALT及AST呈正相关(P＜0.05);HLA-CW1与HLA-A24呈正相关.结论:不同中医证型乙型肝炎患者结局不同,通过HBV-DNA、肝酶及HLA-A24及HLA-CW1的联合检测可以为临床慢性乙型肝炎中医证型分型提供一个方向性指导.     

清肝解毒饮联合西药治疗肝胆湿热型慢性乙型肝炎临床观察

目的:观察清肝解毒饮联合西药治疗肝胆湿热型慢性乙型肝炎的效果。方法:选取2012年6月~2014年6月本院收治的肝胆湿热型慢性乙型肝炎患者94例,按随机数字表法分为对照组和治疗组,每组47例。对照组给予西药治疗,治疗组给予清肝解毒饮联合西药治疗,对比两组的临床疗效。结果:两组ALT、AST、TBIL等肝功能指标均得到明显改善,治疗组的改善程度优于对照组,差异有统计学意义(P0.05);治疗组总有效率为89.36%(42/47),高于对照组的70.21%(33/47),治疗组的HBV-DNA与证候积分优于对照组,对比差异有统计学意义(P0.05)。结论:清肝解毒饮联合西药治疗肝胆湿热型慢性乙型肝炎可改善患者的肝功能与临床症状。     

延续性护理在慢性乙型肝炎患者治疗中的作用

目的探讨延续性护理在慢性乙型肝炎患者的治疗中的应用效果。方法选取我院2016年10月至2017年10月出院的100例慢性乙型肝炎患者为研究对象,随机等分为对照组与观察组。对照组予以常规护理,观察组予以延续性护理,对两组患者的治疗效果、依从性及心理状态进行统计比较。结果观察组患者谷丙转氨酶(ALT)正常率、乙型肝炎病毒(HBV)DNA转阴率、乙型肝炎e抗原(HBeAg)转阴率、HBeAg/乙型肝炎e抗体(抗-HBe)转换率高于对照组,差异有统计学意义(P0.05);观察组患者治疗依从性高于对照组,差异有统计学意义(P0.05);观察组患者抑郁评分、焦虑评分明显低于对照组,两组比较差异有统计学意义(P0.05)。结论在慢性乙型肝炎患者治疗中,实施延续性护理,不仅可有效提高患者治疗依从性,还可降低患者抑郁、焦虑程度。     

慢性乙型肝炎合并重度黄疸患者应用中医整体护理的效果观察

目的探讨中医整体护理在慢性乙型肝炎重度黄疸患者的应用效果。方法 74例慢性乙型肝炎重度黄疸患者随机分为治疗组(n=38)和对照组(n=36)。2组均给予护肝降酶、抗病毒等基础治疗。对照组常规护理,观察组在对照组的基础上加服中药汤剂配合中医整体护理干预。观察2组临床疗效和黄疸持续时间,对比治疗前后总胆红素(TBi L)、内毒素、肿瘤坏死因子(TNF-α)、白细胞介素-6(IL-6)水平。结果治疗组总有效率94.7%,高于对照组的61.1%,差异有统计学意义(P0.05);治疗组患者黄疸持续时间显著短于对照组(P0.05);治疗后,治疗组血清TBi L、血浆内毒素、TNF-α、IL-6水平低于对照组,差异有统计学意义(P0.05或P0.01)。结论中医整体护理能进一步改善慢性乙型肝炎重度黄疸患者临床疗效。     

补肾活血通络方定向透药治疗肾虚血瘀型腰痛研究

目的观察补肾活血通络方定向透药法治疗肾虚血瘀型慢性腰痛的临床疗效。方法将74例肾虚血瘀型慢性腰痛患者随机分为对照组与观察组,每组37例。对照组采用塞来昔布与甲钴胺口服治疗,观察组采用补肾活血通络方定向透药法治疗。比较2组患者治疗前后改良日本骨科学会下腰痛评分法(M-JOA)评分、Oswestry功能障碍指数(ODI)评分、中医证候积分、炎症细胞因子水平,并观察2组治疗效果。结果治疗后,2组M-JOA评分和ODI评分均低于治疗前,且观察组低于对照组,差异有统计学意义(P 0.05);治疗后,2组各项中医证候积分均低于治疗前,且观察组低于对照组,差异有统计学意义(P 0.05);治疗后,2组白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)和白细胞介素-17(IL-17)水平均低于治疗前,且观察组低于对照组,差异有统计学意义(P 0.05);观察组治疗总有效率为94.59%,高于对照组的75.68%,差异有统计学意义(P 0.05)。结论补肾活血通络方定向透药法治疗肾虚血瘀型慢性腰痛疗效可靠,能改善患者症状,缓解腰痛,有效降低炎症细胞因子水平。     

西医常规联合化瘀降浊解毒汤治疗过敏性紫癜的效果及对患儿氧化应激和炎性因子的影响

目的观察西医常规联合化瘀降浊解毒汤治疗过敏性紫癜(HSP)的效果及对患儿氧化应激和炎性因子水平的影响。方法将2016年1月至2017年7月该院收治的HSP患儿124例纳入研究,随机分为观察组和对照组各62例。对照组入院后予以补液、补充维生素、营养支持、保持电解质平衡,同时接受抗过敏、抗血小板、激素等西医常规治疗。观察组在对照组治疗的基础上加用化瘀降浊解毒汤。疗程5周,比较两组的临床治疗效果,以及超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-PX)、丙二醛(MDA)、晚期氧化蛋白产物(AOPPs)、白细胞介素-4(IL-4)、白细胞介素-10(IL-10)、白细胞介素-12(IL-12)和干扰素-γ(IFN-γ)水平。结果观察组的临床疗效优于对照组(Z=2.231,P0.05)。治疗后,两组患儿SOD和GSH-PX水平明显升高(P0.05),且观察组高于对照组(P0.05);MDA和AOPPs水平明显降低(P0.05),且观察组低于对照组(P0.05)。治疗后,两组患儿IL-12和IFN-γ均较治疗前升高,观察组高于对照组(P0.05);IL-4和IL-10均较治疗前降低,观察组低于对照组(P0.05)。结论西医常规联合化瘀降浊解毒汤治疗HSP临床疗效确切,且能有效改善患儿氧化应激状态,减轻炎性反应。     

五虎汤合葶苈大枣泄肺汤加减治疗小儿肺炎支原体肺炎痰热闭肺证临床观察

目的：探讨在小儿肺炎支原体肺炎痰热闭肺证中应用五虎汤合葶苈大枣泄肺汤加减治疗的效果。方法：选择2018年12月~2020年12月收治的84例肺炎支原体肺炎患儿，采用随机数字表法分为对照组和观察组，每组42例。对照组予以西医常规治疗，观察组加用五虎汤合葶苈大枣泄肺汤治疗。比较两组临床疗效、炎症介质水平及不良反应。结果：治疗后，观察组临床总有效率高于对照组，白细胞介素-4、白细胞介素-6及白细胞介素-10水平均低于对照组，差异有统计学意义（P＜0.05）；两组不良反应发生率比较，差异无统计学意义（P＞0.05）。结论：在肺炎支原体肺炎痰热闭肺证患儿中应用五虎汤合葶苈大枣泄肺汤加减治疗效果显著，可有效减轻炎症反应，安全可靠。     

Comparison of platelet immunity in patients with SLE and with ITP

Idiopathic thrombocytopenic purpura (ITP) is characterized by the development of a specific anti-platelet autoantibody immune response mediating the development of thrombocytopenia. Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by the production of a wide variety of autoantibodies. In 15-20% of SLE cases, patients develop thrombocytopenia which appears to be autoimmune in nature (SLE-TP). To better understand the pathogenesis of the thrombocytopenia associated with SLE, we investigated the overlapping platelet and cellular immune features between SLE and ITP. Thirty-one patients with SLE, eight with SLE-TP, and 17 with ITP, were studied and compared to 60 healthy controls. We evaluated platelet-associated IgG, platelet microparticles, reticulated platelets, platelet HLA-DR expression, in vivo cytokine levels, lymphocyte proliferation, and the T lymphocyte anti-platelet immune response in these patients. Patients with SLE-TP and those with ITP had increased platelet-associated IgG, an increased percentage of platelet microparticles, a higher percentage of reticulated platelets and larger platelets, suggesting antibody-mediated platelet destruction and increased platelet production. More than 50% of patients with ITP had increased HLA-DR on their platelet surface whereas subjects with SLE-TP did not. Analysis of serum cytokines demonstrated increased levels of IL-10, IL-15 and TNF-alpha in patients with SLE, but in those with ITP, only increased levels of IL-15 were seen, no increases in any of these cytokines were observed in patients with in SLE-TP. The ability of lymphocytes to proliferate in response to phorbol myristate acetate (PMA) stimulation was increased in SLE-TP, but was normal in both SLE and ITP. Lymphocytes from subjects with ITP displayed an increased ability to proliferate on exposure to platelets, in contrast, those with SLE-TP did not. While the number of subjects evaluated with SLE-TP was small, these data reveal a number of differences in the immunopathogenesis between SLE-TP and ITP.     

Association of optimism-pessimism with quality of life in patients with head and neck and thyroid cancers

OBJECTIVE: To examine the relationship between optimism-pessimism and quality of life (QOL) in survivors of head and neck and thyroid cancers. PATIENTS AND METHODS: Between 1963 and 2000, 190 patients completed both the Minnesota Multiphasic Personality Inventory (MMPI), used to assess explanatory style (optimism-pessimism), and either the 12-Item or 36-Item Short-Form Health Survey (SF-12 or SF-36), used to assess QOL. The MMPIs were completed an average of 13.4 years before the QOL assessment. The QOL measures were completed an average of 12.5 years after cancer diagnosis. Patients were divided into quartiles based on their MMPI Optimism-Pessimism scale score. Analysis was performed for all patients, those with head and neck cancer, and those with thyroid cancer. Adjustments were made for age, sex, and disease stage. RESULTS: For all 190 patients, optimism was associated with a higher QOL on both the mental and the physical component scales and 6 of 8 subscales of the SF-12 and SF-36. For patients with head and neck cancer, optimism was associated with higher QOL on 3 subscales but neither component scale. For patients with thyroid cancer, optimism was associated with higher QOL on both component scales and 6 subscales. After adjusting for age, sex, and disease stage, optimism was not associated with QOL in the head and neck cancer group. CONCLUSIONS: Optimism was associated with a higher QOL in survivors of thyroid cancer compared with survivors of head and neck cancer. After adjusting for age, sex, and disease stage, optimism was not associated with QOL for survivors of head and neck cancer. Optimism was more associated with the mental rather than physical QOL subscales.     

培哚普利和苯磺酸氨氯地平联合应用对高血压蛋白尿的作用

目的 观察培哚普利和苯磺酸氨氯地平联合应用治疗高血压蛋白尿的临床疗效.方法 将136例高血压合并肾脏损害蛋白尿的患者随机分为A、B两组,A组给予培哚普利4 mg/d和苯磺酸氨氯地平5 mg/d,B组给予苯磺酸氨氯地平5 mg/d和氢氯噻嗪12.5 mg/d,均治疗26周.两组治疗前及治疗后测血压、尿白蛋白、尿素氮(BUN)、血肌酐(Scr),并计算肌酐清除率(Ccr)和不良反应.结果 两组治疗后6.5个月,血压较前明显下降(P＜0.01),两组下降值比较差异无统计学意义(P＞0.05).两组治疗后尿蛋白均下降(P＜0.05),A组降低尿蛋白作用比B组更显著(P＜0.01).A组降低Scr、BUN更显著(P＜0.05).结论 培哚普利和氨氯地平联合应用能明显较平稳降低高血压,显著减少尿蛋白,有效保护肾功能.     

宫腹腔镜联合诊治不孕症82例临床价值和意义

目的探讨宫腹腔镜联合诊治不孕症在临床中的价值及意义。方法2001年4月～2004年5月该院从172例已行传统B超＋HSG＋诊刮检查的不孕症病例中随机选择82例进一步行宫腹腔镜联合诊治（联合组），余90例作为对照（对照组），观察两种检查方法的阳性检出率、诊断准确率和两组术后妊娠率。结果联合镜检法发现病变72例，阳性率87、80％，其中11例有两种以上病变，占13．40％；传统法发现病变32例，阳性率39．02％，其诊断准确率为43．80％。对所有病变术中同时给予治疗，成功率95．83％，经随访2年，联合组及对照组术后妊娠率分别为32．90％和2．35％，两种方法及两组效果比较差异有显著性（P〈0．01）。结论宫腹腔镜联合用于不孕症，集检查治疗为一体，一次手术即可完成宫腔内及盆腔的检查及治疗，直观，准确，全面，疗效可靠，损伤轻，有较高应用价值，值得临床推广。