近10年岭南地区肾病综合征中医辨证分型及用药规律的文献分析

【目的】探讨岭南地区肾病综合征的中医证候规律及用药规律。【方法】通过对2003~2013年岭南地区肾病综合征的中医证候研究文献及中医药治疗肾病综合征的临床研究文献进行梳理,总结分析肾病综合征的中医证候规律及用药规律。【结果】(1)7篇中医证候研究文献共558例肾病综合征中医证型的构成比排在前5位的依次是:脾肾阳虚型、阴虚湿热型、脾肾气虚型、风邪外袭型、瘀水交阻型。(2)31篇中医药治疗肾病综合征的临床研究文献中,基本用药中占前5位的药物分别为茯苓、黄芪、白术、泽泻、山药。基本用药类前4种为补虚药、利水渗湿药、清热药、活血化瘀药,占其药物组成的81.42%;基本用药中的药物多归肾经、肝经、脾经、心经,占其药物组成的68.26%;基本用药中的药味以甘、苦、辛为主,占其药物组成的82.91%,药性以温、寒、平为主,占其药物组成的94.62%。【结论】岭南地区肾病综合征的辨证分型以脾肾阳虚、阴虚湿热为主,同时具有多样化、复杂性特点。岭南医家治疗肾病综合征用药是以补虚药、利水渗湿药和清热药为主,同时适当运用活血化瘀和解表药。其用药归经多归肾、肝、脾、肺经,药味以甘、苦、辛为主,药性以温、寒、平为主。     

中医治疗小儿泌尿道感染文献计量学分析

检索1990—2016年学者在知网、万方数据库及MEDLINE等发表的与小儿泌尿道感染中医药文献574篇,严格按照纳入标准和排除标准对检索到的文献进行筛选分类,最终得到205篇中医及中西医结合治疗文献,7篇名老中医经验文献。通过文献学的计量方法,对文献的整体质量、中医辨证、选方、用药以及诊疗标准进行统计分析,全面了解小儿泌尿道感染中医治疗的情况及发展趋势。分析结果认为,小儿泌尿道感染的常见中医证候为膀胱湿热证、心火炽盛证、肝肾阴虚证、脾肾气虚证和气阴两虚证,中药方剂以八正散、知柏地黄丸、导赤散为基础方进行加减的应用频率较高,中药单味药以瞿麦、萹蓄、滑石、车前子、木通等为多见。针对这205篇文献进一步分析时发现,对于小儿泌尿道感染的诊断标准和疗效标准评价方法多种多样,缺乏统一规范的诊断、疗效标准评价体系,说明在该领域并未形成规范诊疗标准。     

原发性肾病综合征中医证候荟萃分析

目的研究原发性肾病综合征的中医证候分布,总结其主要的证候类型。方法通过计算机检索国内1997-2010年关于中医药治疗原发性肾病综合征的文献,运用随机对照试验表对文献进行评估,采用JADAD治疗评分表对文献进行评价,将符合标准的文献运用加权百分率法进行荟萃分析。结果共有9篇文献入选本研究,得到701例病人15种证型,其中主要的证型为脾肾阳虚型(29.5%)、肝肾阴虚型(16.7%)、阴虚湿热型(13.8%)。结论脾肾阳虚、肝肾阴虚、阴虚湿热为原发性肾病综合征的主要证型。     

文献研究对现代中医药发展的作用及影响

现代中医药发展主要体现在中医教学、科研和临床,3者均离不开文献研究。既往中医教学的内容来源于文献,今后中医教育改革必须依靠文献研究;中医药科研应以中医药文献研究为基础,研究思路不能偏离中医药本体理论,从文献中可以挖掘更多的研究目标;文献研究对于发扬中医治病优势,拓宽临证思路,提高中医疗效具有十分重要的意义。     

难治性肾病综合征的中医内治法治疗进展

难治性肾病综合征是指对糖皮质激素抵抗、依赖和(或)频繁复发的肾病综合征,占原发性肾病综合征的30%~50%,其临床表现较重,治疗棘手,预后较差。中医药治疗难治性肾病综合征,在降低尿蛋白及改善临床症状方面疗效突出,且不良反应相对小。但是在辨证客观化、证候规范化、药物作用机制等方面与循证医学要求尚有一定差距,在一定程度上限制了中医的发展。笔者将近年来中医对难治性肾病综合征的辨证、治疗进行总结。     

IgA肾病中医证候、临床表现与肾脏病理的关系

IgA肾病中医证候、临床表现与肾脏病理改变有一定的相关性,对推断病情、预后及提高中医药治疗IgA肾病的疗效及预防和延缓肾衰竭有重要意义,并为中医研究提供思路。     

肥胖的中医药疗法研究进展

对近15年中医药治疗肥胖的随机对照临床研究进行综述,对中医药治疗肥胖的不同疗法进行分析,认为中医药治疗肥胖在减轻体重、改善脂质代谢和相关证候等方面有一定疗效,但仍存在诊断标准不统一、辨证分型标准不统一、报告质量较差、疗效评价无法体现中医治疗优势等不足。建议在今后中医药治疗肥胖的研究中,制定规范的诊断辨证分型标准与疗效评价标准,开展大规模、多中心、随机对照的中医药治疗肥胖症临床试验,科学地总结中医药治疗肥胖的规律,反映中医药治疗肥胖的优势。     

基于微炎症状态探讨小儿原发性肾病综合征中医药辨治

小儿原发性肾病综合征(PNS)是儿科常见的肾系疾病,发病机制尚不清楚,近年发病率逐渐升高,治疗颇为棘手,严重影响小儿的身体健康和生活质量。笔者通过微炎症状态对小儿原发性肾病综合征影响的相关文献疏理,从中医药角度探讨小儿肾病综合征微炎症状态的发病特点及辨治方药,从而为中医药治疗小儿肾病综合征提供理论依据。     

中医药治疗痛风性肾病文献质量评价与分析

目的对中医药治疗痛风性肾病(gouty nephropathy,GN)的临床随机对照试验(randomizedcontrolledtrials,RCT)进行文献质量评价与分析。方法以中医药/中药(包括各剂型)治疗、痛风肾/痛风性肾病为检索词,检索了中国知网数据库。对纳入研究的报告质量,包括研究设计的方法学质量、诊断与纳入/排除标准、中医药/对照组干预措施、疗效评价标准及观察时间点、不良反应报告、中医药内容等方面进行评价。结果共纳入31文献,2408例患者,改良后的Jadad量表评分1篇属高质量研究(4～7分),余均属于低质量研究。文献质量评价结果显示,目前国内关于中医药治疗GN高质量临床研究报道较少,诊断标准、中医证候诊断标准及疗效标准尚未得到统一,随机、对照设置欠合理。结论从目前的临床报道来看,中医药治疗痛风性肾病具有一定疗效,但文献质量尚不可观,仍需要进行进一步高质量的临床研究。     

中医药治疗痰湿型多囊卵巢综合征的研究进展

多囊卵巢综合征(PCOS)是育龄期女性的常见病、多发病,以月经不调、生殖功能障碍、高雄激素血症、胰岛素抵抗及糖脂代谢异常为主要临床表现,远期并发症有2型糖尿病、心血管疾病,代谢综合征及子宫内膜癌等。具有发病多因性、表现异质性,是妇科常见的疑难病症。痰湿型PCOS因其独特的临床特征,故临证治疗与非痰湿型PCOS存在较大差异,一直被视为难题,西医对痰湿型PCOS的认识相对统一,诊疗规范、方案固定,然而大量文献研究结果显示中医药治疗痰湿型PCOS有其独特的优势,临床疗效已被国内外医学界所认可。文章旨在总结最新文献研究结果,以期为痰湿型PCOS的治疗提供理论依据。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.