英夫利昔联合美沙拉嗪治疗IBD效果及不良反应

目的探讨英夫利昔联合美沙拉嗪治疗炎症性肠病(IBD)效果及不良反应。方法将120例IBD患者采用随机数字表字法分为观察组和对照组,每组60例。两组均予以美沙拉嗪治疗,观察组在此基础上增加英夫利昔治疗。比较两组临床疗效、溃疡性结肠炎(UC)和克罗恩病(CD)治疗有效率、疾病活动度[简化CD活动指数(CDAI)、简化UC活动指数(CAI)],治疗前、治疗2个月后评估患者肠道菌群改变、血清炎症因子水平、营养状况、不良反应发生率。结果治疗2个月后,观察组治疗总有效率高于对照组(P0.05);两组UC、CD治疗有效率比较,差异均无统计学意义(P0.05);治疗2个月后,两组CDAI和CAI得分均低于治疗前(P0.05),观察组降幅均大于对照组(P0.05);治疗2个月后,两组消化球菌、肠球菌、双歧杆菌数量、C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、血沉(ESR)及营养不良率均低于治疗前(P0.05),乳酸杆菌数量、血红蛋白(HB)、白蛋白(ALB)水平高于治疗前(P0.05),观察组变动幅度大于对照组(P0.05);两组不良反应率比较,差异无统计学意义(P0.05)。结论英夫利昔联合美沙拉嗪治疗IBD安全有效,更有利于改善患者肠道菌群结构、炎性因子水平和营养状况。     

美沙拉嗪联合固本益肠片对溃疡性结肠炎患者炎症因子及肠黏膜屏障功能的影响

[目的]探讨美沙拉嗪联合固本益肠片对溃疡性结肠炎(ulcerative colitis,UC)患者炎症因子及肠黏膜屏障功能的影响。[方法]入选80例UC患者为研究对象,根据患者对治疗方案的选择分为观察组(40例)和对照组(40例);观察组口服美沙拉嗪联合固本益肠片治疗,对照组单服美沙拉嗪治疗。观察2组治疗前后炎症因子、肠黏膜屏障功能、肠道菌群及中医证候积分的变化。[结果]治疗前2组患者炎症因子、肠黏膜屏障功能、肠道菌群及中医证候积分水平比较均差异无统计学意义(P0.05)。疗程结束后与治疗前比较,观察组INF-γ水平无明显变化,对照组INF-γ水平明显升高(P0.05);2组IL-1β、IL-17、IL-23、D-乳酸、UAMY、DAO水平均较治疗前明显降低(P0.05)。与治疗前比较,疗程结束后2组肠球菌、大肠埃希菌明显减少,乳酸杆菌、双歧杆菌明显增加(P0.05),各项中医证候积分明显降低(P0.05);观察组治疗后各项指标变化水平均明显优于对照组(P0.05)。[结论]美沙拉嗪联合固本益肠片比单独使用美沙拉嗪治疗UC效果更好,安全性更高,值得临床推广应用。     

双歧三联活菌胶囊联合甘草泻心汤对溃疡性结肠炎患者肠道菌群和肠黏膜屏障的影响

[目的]探讨双歧三联活菌胶囊联合甘草泻心汤对溃疡性结肠炎(UC)患者肠道菌群和肠黏膜屏障的影响。[方法]选取84例活动期UC(寒热错杂型)患者随机分为观察组和对照组。2组均予以美沙拉嗪肠溶片1.0g/次,4次/d,口服。观察组予以双歧三联活菌胶囊联合甘草泻心汤,对照组予以单纯的甘草泻心汤治疗,2组疗程均为8周。观察并记录2组治疗前和治疗8周后肠道菌群[乳酸杆菌、双歧杆菌、大肠杆菌和双歧杆菌(B)与大肠杆菌(E)的比值]数量及肠黏膜屏障指标[血清D-乳酸和二胺氧化酶(DAO)]的变化,并评估肠镜下肠黏膜评分的变化。[结果]治疗8周后,2组双歧杆菌、乳酸杆菌数量及B/E比值明显上升,大肠杆菌数量下降(P0.05),且观察组变化幅度较对照组更大(P0.05);2组血清D-乳酸和DAO指标明显下降(P0.05或P0.01),且观察组下降值较对照组更大(P0.05);同时2组肠镜下肠黏膜评分明显下降(P0.05或P0.01),且观察组下降值较对照组更大(P0.05)。[结论]双歧三联活菌胶囊联合甘草泻心汤治疗UC患者可纠正肠道微生态平衡紊乱,重建肠道微生态平衡;并可修复肠黏膜屏障,改善肠镜下肠黏膜病变程度。     

复方黄柏液灌肠联合美沙拉嗪对溃疡性结肠炎患者黏附因子的影响及疗效分析

[目的]探讨复方黄柏液灌肠联合美沙拉嗪对溃疡性结肠炎(UC)患者黏附因子的影响,并进行疗效分析。[方法]选择2015-03-2017-08期间收治的90例UC患者,依据随机数字表法分为研究组与对照组,各45例。对照组采用口服美沙拉嗪1 g/次、4次/d治疗,研究组采用复方黄柏液灌肠联合口服美沙拉嗪治疗,剂量同上。疗程均为3个月。比较2组患者治疗前后的症状积分、肠镜积分、肠道菌群数量及黏附因子的变化,分析2组患者的疗效。[结果]研究组与对照组患者治疗前症状积分、肠镜积分、肠道菌群数量及黏附因子比较均差异无统计学意义(P0.05);治疗后,2组患者腹痛、腹泻、脓血便症状积分及肠镜积分均降低,研究组患者各项积分均显著低于对照组(P0.05)。2组患者经治疗后肠球菌数量、ICAM-1及VCAM-1水平显著降低,双歧杆菌与乳酸杆菌数量显著升高(均P0.05);且研究组患者肠球菌数量、ICAM-1及VCAM-1水平显著低于对照组,双歧杆菌与乳酸杆菌的数量显著高于对照组(均P0.05)。研究组有效率显著高于对照组(93.33%∶75.56%,P0.05)。[结论]复方黄柏液灌肠联合美沙拉嗪治疗UC患者,可显著改善其临床症状及菌群紊乱,下调黏附因子的表达,治疗效果较好。     

ω-3多不饱和脂肪酸联合美沙拉嗪治疗炎症性肠病患者疗效及对肠道菌群的影响

目的 探讨ω-3多不饱和脂肪酸(PUFAs)联合美沙拉嗪对炎症性肠病(IBD)患者的治疗效果及对肠道菌群的影响。方法 选取2020年6月至2023年6月在本院就诊的炎症性肠病患者80例,采用随机数表法分为联合组与美沙拉嗪组各40例,美沙拉嗪组使用美沙拉嗪治疗,联合组使用ω-3多不饱和脂肪酸联合美沙拉嗪治疗。对比联合组与美沙拉嗪组临床疗效以及治疗前、治疗3个月后肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、白细胞介素-1(IL-1)、外周血T淋巴细胞亚群[CD³⁺、CD⁴⁺、CD⁸⁺]、肠道菌群水平和不良反应发生率。结果 联合组总有效率为95.00%,显著高于美沙拉嗪组80.00%(P<0.05);治疗3个月后联合组患者体内CD⁸⁺、TNF-α、IL-6、IL-1、大肠杆菌、肠球菌水平低于美沙拉嗪组(P<0.05),CD³⁺、CD⁴⁺、双歧杆菌、乳酸杆菌水平高于美沙拉嗪组(P<0.05);两组间不良反应发生率无显著差异(χ     

美沙拉嗪联合益生菌对老年中度活动期溃疡性结肠炎患者细胞因子水平的影响

目的研究美沙拉嗪联合益生菌对老年中度活动期溃疡性结肠炎患者因子的影响。方法选取100例老年中度活动期溃疡性结肠炎患者,按照随机分组的方式,分为对照组和研究组各50例。对照组予口服美沙拉嗪1.0 g/次,4次/d;研究组予口服美沙拉嗪联合益生菌(双歧三联活菌420 mg/次,3次/d)。两组均治疗8 w,观察比较两组治疗后总有效率及血清超氧化物歧化酶(SOD)、丙二醛(MDA)、肿瘤坏死因子(TNF)-α的水平。结果研究组治疗后总有效率明显大于对照组,差异有统计学意义(P0.05);研究组血清MDA、TNF-α水平明显较对照组降低,差异有统计学意义(P0.05)。研究组血清SOD水平明显高于对照组,差异有统计学意义(P0.05)。结论益生菌联合美沙拉嗪治疗老年中度活动期溃疡性结肠炎,可调节患者相关细胞因子的水平,其效果优于单用美沙拉嗪。     

双歧杆菌三联活菌胶囊联合美沙拉嗪对溃疡性结肠炎患者免疫功能及肠黏膜屏障功能的影响

目的探讨双歧杆菌三联活菌胶囊联合美沙拉嗪对溃疡性结肠炎患者免疫功能及肠黏膜屏障功能的影响。方法选择成都市青白江区人民医院在2015年7月至2016年6月期间收治的108例溃疡性结肠炎患者作为研究对象,采用随机数字表法分为观察组和对照组,每组各54例。对照组给予美沙拉嗪肠溶片治疗,观察组给予双歧杆菌三联活菌胶囊联合美沙拉嗪治疗。治疗8周后,比较两组的免疫功能、肠黏膜屏障功能、不良反应、临床疗效等指标。结果治疗后,观察组有效率(90.74%)明显高于对照组(75.93%),差异具有统计学意义(P0.05);观察组T淋巴细胞CD4+含量、CD4+/CD8+比值明显高于对照组,CD8+含量明显低于对照组,差异均具有统计学意义(P均0.05);观察组血清D-乳酸、二胺氧化酶(DAO)、内毒素(ET)含量明显低于对照组,差异均具有统计学意义(P均0.05);两组不良反应比较差异无统计学意义(P0.05)。结论双歧杆菌三联活菌胶囊联合美沙拉嗪有助于提高溃疡性结肠炎患者的临床疗效,这可能与改善患者免疫功能、肠黏膜屏障功能等因素有关。     

ω-3多不饱和脂肪酸对炎症性肠病患者免疫细胞功能及炎性指标的影响

目的 探究ω-3多不饱和脂肪酸(ω-3PUFAs)对炎症性肠病(IBD)患者免疫细胞功能及炎性指标的影响。方法 选取2019年10月2020年12月新疆医科大学第五附属医院消化科120例IBD患者,随机分为观察组和对照组,各60例。对照组患者实施美沙拉嗪治疗方案,观察组患者在对照组基础上予以ω-3PUFAs制剂治疗。比较两组治疗10周后疗效表现,比较两组治疗前及治疗10周后免疫细胞功能(CD3⁺、CD4⁺、CD8⁺、NK细胞)、炎性指标[肿瘤坏死因子(TNF-α)、C反应蛋白(CRP)、白介素-6(IL-6)]、肠屏障功能[二胺氧化酶(DAO)、D-乳酸(D-LA)、内毒素(ET)]、肠道菌群(双歧杆菌、大肠埃希菌、乳酸杆菌、肠球菌)水平。结果 治疗10周后,观察组总有效率显著高于对照组(P均<0.05);两组CD3⁺、CD4⁺、NK细胞、双歧杆菌、乳酸杆菌水平均较治疗前显著升高,且观察组明显高于对照组(P均<0.05);两组CD8⁺、TNF-...     

清肠化湿灌肠方联合美沙拉嗪治疗远端溃疡性结肠炎的临床疗效

目的:观察清肠化湿灌肠方联合美沙拉嗪口服治疗轻中度远段溃疡性结肠炎的疗效.方法:48例轻、中度活动期远段溃疡性结肠炎患者,随机分成两组:治疗组25例,清肠化湿灌肠方保留灌肠,同时给予美沙拉嗪口服;对照组23例,仅给予美沙拉嗪口服,两组共治疗12 Wk.治疗结束后比较两组患者治疗前后的疗效、主要症状消失率、疾病活动指数(sutherland,DAI)及对血沉(erythrocyte sedimentation rate,ESR)、血小板(blood platelet,PLT)指标的影响;观察不良反应的发生情况.结果:治疗12 wk后,治疗组总有效率明显高于对照组(P0.05);主要症状腹泻、便血的消失率均优于对照组(P0.05);两组患者治疗后DAI均下降,对照组下降程度低于治疗组,有统计学差异(P0.01);两组患者治疗后ESR、PLT均下降,对照组下降程度低于治疗组,有统计学差异(P0.05).两组用药后各出现1例上腹不适,头晕、恶心等症状,均自行缓解;对照组发生谷丙转氨酶、谷草转氨酶轻度升高1例,予保肝治疗后恢复正常.结论:清肠化湿灌肠方联合美沙拉嗪口服,可明显改善轻中度远段溃疡性结肠炎患者症状,降低疾病活动指数,降低ESR、PLT数值,有效安全,且近期临床疗效优于单用美沙拉嗪.     

美沙拉嗪联合益生菌对炎症性肠病的疗效及血清炎性因子的影响

目的探讨美沙拉嗪联合益生菌对炎症性肠病(IBD)的疗效及其对血清炎性因子的影响。方法采用随机数字表法将82例IBD患者分为对照组和观察组,每组各41例,对照组给予美沙拉嗪治疗(每日3次,每次0.1g),观察组在此基础上联合益生菌治疗(培菲康,每日3次,每次2粒)。比较两组的临床疗效、结肠镜复查结果、血清炎性因子水平、疾病活动指数(DAI)以及治疗期间的不良反应。结果观察组的临床疗效和结肠镜复查结果的总体有效率为95.12%和90.24%,明显高于对照组的70.73%和73.17%(P0.05)。治疗后观察组的血清肿瘤坏死因子-α(TNF-α)、白细胞介素-8(IL-8)、IL-17、IL-23水平明显低于对照组(P0.05),IL-10水平明显高于对照组(P0.05)。观察组的DAI评分为(3.21±1.04),明显低于对照组的(6.14±1.38)(P0.05)。观察组的不良反应发生率为9.76%,低于对照组的24.39%,但两组差异无统计学意义(P0.05)。结论美沙拉嗪联合益生菌治疗IBD能明显提高疗效,并能调节血清炎性因子水平,降低DAI,值得临床推广应用。     

Treatment of patients with Eisenmenger's syndrome with Bosentan

We treated prospectively 14 patients with Eisenmenger's syndrome, with a mean age of 10 years, ranging from 3 to 18 years. Treatment continued for 12 months, and demonstrated a lasting symptomatic improvement, but no improvement in terms of mean saturation of oxygen over 24 hours. Exercise capacity, as judged by peak uptake of oxygen, worsened in the six patients able to perform a treadmill test. The symptomatic benefit from dual blockage of endothelin receptors in these patients may be due to mechanisms other than selective pulmonary vasodilatation alone.     

Satisfaction with ambulatory care of persons with AIDS

OBJECTIVE: To examine the relation of patient characteristics and site of care to the perception of ambulatory care quality by persons with AIDS (PWAs). DESIGN: Patient surveys and medical record review were used to determine PWAs’ perceptions of their ambulatory care, self-perceived health status, primary care relationships, sociodemographic characteristics, and severity of illness. SETTING: A public-hospital HIV clinic, an academic group practice, and a staff-model health maintenance organization (HMO) that together care for 20% of all Massachusetts PWAs. PATIENTS: All active patients as of February 12, 1990, and all new AIDS patients at each of the three sites during the subsequent 13 months. MEASUREMENTS AND MAIN BESULTS: The primary outcome measure was a six-item scale of patient-rated quality of care (PRQC), a newly developed measure that combined patients’ ratings of their physician care, nursing care, involvement in medical decisions, and overall quality of care. Multiple logistic regression was carried out with low PRQC (lowest quart He) as the dependent variable, to identify correlates of patient perceptions of poor quality. Patients who had a primary nurse were significantly less likely to have low PRQC scores (OR=0.50, 95% CI=0.26 to 0.97). Black patients and patients who used injection drugs were significantly more likely to rate their care in the lowest quartile (OR=2.22, 95% CI=1.04 to 4.78; and OR=2.43, 95% CI=1.13 to 5.23, respectively), as were those who had lower self-perceived health status, after controlling for confounders; no association was found by site or severity. CONCLUSIONS: These results show that primary nursing may be an important determinant of how PWAs rate the quality of their ambulatory care. Furthermore, PWAs who are black or who are injection drug users are less satisfied than are others with the quality of their ambulatory AIDS care. Presented in part at the annual meeting of the Society of General Internal Medicine, April 30, 1993, Arlington, Virginia. Supported by the Agency for Health Care Policy and Research, grant number HS06239.     

Experience with the treatment of patients with hypertrophic cardiomyopathy with obsidan and isoptin

Forty-five patients with hypertrophic cardiomyopathy were examined clinically and echocardiographically. The results of their treatment with obsidan and isoptin in relation to various types of central hemodynamic disorders are presented. The data have been obtained making it possible to treat patients differentially with regard to the form of the disease. The treatment of this category of patients requires the echocardiographic monitoring of the parameters of the central hemodynamics and myocardial contractility.     

分析老年糖尿病患者应用甘精胰岛素联合阿卡波糖治疗的效果

目的探讨甘精胰岛素联合阿卡波糖在老年糖尿病患者中的临床疗效。方法选取该院2018年7月—2019年7月收治的113例老年糖尿病患者作为研究对象,经随机数字表法,划分A组(n=56,阿卡波糖)和B组(n=57,甘精胰岛素+阿卡波糖),比较两组临床疗效、血糖指标。结果B组患者临床治疗总有效率显著高于A组;经治疗,B组患者空腹血糖(FBG)、餐后2 h血糖(2 hPG)、糖化血红蛋白(HbAlc)水平明显低于A组。两组之间比较差异有统计学意义(P<0.05)。结论在老年糖尿病患者中应用甘精胰岛素+阿卡波糖,临床疗效显著,使患者的空腹血糖、餐后2 h血糖、糖化血红蛋白等指标得到了明显改善,安全性强。     

Evaluation of atrial vulnerability with transoesophageal stimulation in patients with atrioventricular junctional: Comparison with patients with ventricular pre-excitation and with normal subjects

The aim of our work was to evaluate the inducibility of atrialfibrillation in a group of patients with atrioventricular junctionalreentrant tachycardia and to compare it with that of patientswith a Kent-type ventricular pre-excitation (Wolff-Parkinson-Whitesyndrome) and a control group. One hundred and twenty-five subjects were separated into groups.Group 1 comprised 49 Wolff-Parkinson-White patients, with amean age of 26.4, range 10.66 years; group 2, 51 patients withatrioventricular junctional reentrant tachycardia inducibleby transoesophageal atrial stimulation andlor clinically documented,with a mean age of 43.4, range 16–78 years; group 3, 25control subjects with a mean age of2.64, range 13–76 years. Each subject underwent atrial transoesophageal stimulation withthe following protocol: programmed atrial stimulation with 1and 2 stimuli during atrial pacing of 100. min^–1 and 150.min^–1; atrial stimulation for 10 s at a rate of 200–300–400–500–600.min^–1 with intervals of 10 s between stimulations, fivesuccessive ‘ramp-up’ atrial stimulations for 9 swith the rate increasing from 100 to 800. min^–1 with intervalsof 10 s between stimulations. The end point was the completionof the protocol or induction of sustained atrial fibrillation(>1 min). The chi-square test was used for statistical analysis. Our resultsshowed that in group 1 atrial fibrillation was induced in 27149patients (55.1%); this was sustained in 13149 (26.5%) and non-sustainedin 14149 (28.5%); in group 2, atrial fibrillation was inducedin 22151 patients (43.0%); it was sustained in 7151 (13.7%)and non-sustained in 15151 (29.4%); in group 3, sustained atrialfibrillation was not induced in any subject and in only onesubject was a non-sustained atrial fibrillation (4 s) induced. The chi-square test showed that group 2 vs group 1 were non-significant,while group 2 vs group 3 and group 1 vs group 3 were significant(P<0.003 and P<0.0007, respectively). Therefore group 2 patients showed a greater atrial vulnerabilityin comparison to the control subjects and a similar vulnerabilityto group 1 patients. It is possible that the greater atrialvulnerability in the patients of group 2 was due to the doublenodal pathway.