滋肾健脾方联合淋巴细胞免疫治疗复发性流产脾肾两虚证临床研究

目的观察滋肾健脾方联合淋巴细胞免疫治疗复发性流产(RSA)脾肾两虚证的疗效及安全性。方法将120例复发性流产脾肾两虚证患者随机分为对照组和治疗组,各60例。对照组采用淋巴细胞免疫,观察组在对照组治疗基础上给予滋肾健脾方,观察患者中医证候评分,血清封闭抗体(CD3~+、CD4~+、CD8~+、CD4~+/CD8~+)和炎症因子(IFN-γ、TNF-α、IL-1β、IL-10)水平;比较2组患者有效率和不良反应发生率。结果研究期间对照组脱落3例,治疗组脱落2例。治疗组生产率89.7%,高于对照组的71.9%(P0.05)。治疗组总有效率94.8%,高于对照组的80.7%(P0.05)。治疗组患者的中医证候评分、血清封闭抗体和炎症因子水平均明显改善,优于对照组(P0.05~0.01)。治疗组不良反应发生率10.3%(6/58)低于对照组的28.1%(16/57)(P0.05)。结论滋肾健脾方联合淋巴细胞免疫治疗复发性流产脾肾两虚证能明显提高足月分娩率,其机理可能与调节血清封闭抗体及炎症因子水平有关。     

益肺增效汤配合NP方案治疗晚期肺癌临床研究

目的:探讨益肺增效汤配合NP方案治疗晚期肺癌的临床疗效,评价其安全性。方法:选取86例晚期非小细胞肺癌患者作为研究对象,采用数字随机表法分为对照组和观察组,对照组给予NP方案治疗,观察组在对照组基础上给予益肺增效汤治疗,观察两组患者临床疗效、卡氏评分及中医证候评分,比较T淋巴细胞亚群变化情况及Ⅱ~Ⅳ级化疗不良反应。结果:观察组治疗有效率为83.72%,对照组有效率为62.79%,两组比较,差异有统计学意义(P0.05);观察组治疗后卡氏评分为(87.36±7.11)分,中医证候评分为(7.21±1.58)分,对照组治疗后卡氏评分为(75.36±6.98)分,中医证候评分为(11.38±2.27),分,两组比较,差异有统计学意义(P0.05);观察组治疗后CD+3、CD+4、CD+4/CD+8分别为(64.75±5.29)%、(37.02±5.31)%,(1.62±0.57)%,显著高于对照组,差异有统计学意义(P0.05);观察组Ⅱ~Ⅳ级白细胞减少、消化道反应发生率分别为2.33%、6.98%,对照组分别为13.95%、23.26%,两组比较,差异有统计学意义(P0.05)。结论:益肺增效汤配合NP方案治疗晚期肺癌能够减轻化疗不良反应,改善免疫功能,提高临床疗效。     

益气抗癌汤联合化疗治疗晚期非小细胞肺癌临床疗效观察

目的:观察益气抗癌汤联合化疗治疗晚期非小细胞肺癌的临床疗效。方法:应用随机平行对照方法,按住院病志号随机将95例住院患者分为两组。对照组48例应用TP方案化疗,治疗组47例患者应用益气抗癌汤200 m L,日3次口服;化疗用法、用量同对照组,治疗20 d为1个疗程。行3周期化疗后观察中医证候改善情况、卡式评分、T淋巴细胞亚群(CD3+、CD4+、CD8+)及NK细胞、生活质量、相关毒副作用、近期疗效。结果:两组治疗有效率比较,治疗组(62.5%)优于对照组(53.2%),差异无统计学意义(P0.05);治疗组中医证候改善率(70.83%)优于对照组(51.06%);治疗组卡氏评分增加的稳定率(66.7%)优于对照组(42.5%);治疗后,治疗组CD3+、CD4+、CD4+/CD8+、NK细胞百分比均升高,与治疗前相比差异明显(P0.05)。与对照组治疗后结果相比,差异显著(P0.05)。治疗组血红蛋白、白细胞及血小板减少程度均小于对照组(P0.05)。结论:益气抗癌汤联合化疗治疗晚期非小细胞肺癌,可明显减轻化疗的毒副作用、改善中医证候、缓解不适症状、提升患者生存质量,临床疗效可靠。     

解毒散瘀汤治疗儿童热毒炽盛型传染性单核细胞增多症80例的临床研究

目的:观察解毒散瘀汤治疗儿童热毒炽盛型传染性单核细胞增多症的临床效果。方法:选取热毒炽盛型传染性单核细胞增多症患儿80例,依据治疗方法不同分为观察组和对照组,每组各40例。对照组予以西医常规治疗,观察组用解毒散瘀汤治疗,分析比较两组中医证候疗效、体征评分、免疫功能及不良反应。结果:治疗后,观察组临床症状和体征评分显著低于对照组(P<0.01);观察组临床治疗总有效率为95.00%,明显高于对照组的77.50%(P<0.05);观察组CD3+明显低于对照组,CD4~+、CD4~+/CD8~+显著高于对照组(P<0.01);对照组不良反应总发生率15.00%,明显高于观察组的不良反应(P>0.05)。结论:解毒散瘀汤治疗儿童热毒炽盛型传染性单核细胞增多症效果显著,并可降低不良反应发生率。     

升阳益肾汤治疗脾肾阳虚型老年常年性变应性鼻炎

目的:观察升阳益肾汤治疗脾肾阳虚型老年常年性变应性鼻炎的临床疗效。方法:将96例脾肾阳虚型老年常年性变应性鼻炎患者按就诊编号分为两组,每组48例。对照组采用常规西药治疗,观察组采用升阳益肾汤治疗。两组患者均进行6个月的随访。比较两组患者治疗前后中医证候积分、白细胞介素-2(interleukin-2,IL-2)、白细胞介素-4(interleukin-4,IL-4)、生存质量评分变化情况、不良反应发生情况和临床疗效。结果:治疗后两组患者血清IL-2水平、生存质量评分较治疗前均明显上升,而血清IL-4水平、中医证候积分较治疗前均明显下降,差异均有统计学意义(P 0. 05);治疗后,观察组的血清IL-2水平、生存质量评分均明显高于对照组,而血清IL-4水平、中医证候积分均明显低于对照组,差异均有统计学意义(P 0. 05);观察组的不良反应发生率为8. 33%,明显低于对照组的29. 17%,差异有统计学意义(P 0. 05);观察组有效率为85. 42%,明显高于对照组的64. 58%,差异有统计学意义(P 0. 05)。结论:应用升阳益肾汤对脾肾阳虚型老年常年性变应性鼻炎患者进行治疗,可有效改善血清IL-2、IL-4水平,疗效显著。     

清热消痤颗粒对炎症性痤疮患者炎症细胞因子水平的影响

目的观察清热消痤颗粒治疗炎症性痤疮对患者炎症细胞因子水平的影响。方法选取我院门诊于2013年7月~2015年12月收治的青春期炎症性痤疮患者81例作为研究对象,分为观察组(43例)与对照组(38例)。观察组应用清热消痤颗粒治疗,对照组口服丹参酮颗粒。比较两组治疗前后中医证候积分、治疗总有效率、治疗前后炎症细胞因子水平(IL-4、IFN-γ)、不良反应发生率。结果两组治疗前的中医证候积分差异无统计学意义(P0.05);治疗后两组中医证候积分均降低(P0.01),观察组中医证候积分低于对照组,差异有统计学意义(P0.01)。观察组治疗总有效率为88.4%,高于对照组68.4%,差异有统计学意义(P0.05)。治疗后两组炎症细胞因子IL-4水平均降低、IFN-γ水平均升高(P0.05),且观察组IL-4水平低于对照组、IFN-γ水平高于对照组,差异有统计学意义(P0.05或P0.01)。观察组与对照组的不良反应发生率分别为7.0%、10.5%,差异无统计学意义(P0.05)。结论清热消痤颗粒治疗炎症性痤疮可疏风清热、化瘀解毒,切中病机,并降低IL-4、升高IFN-γ,且不良反应少。     

中满分消汤联合七味胃痛胶囊治疗消化性溃疡临床观察

目的:探讨中满分消汤联合七味胃痛胶囊治疗消化性溃疡的临床疗效及安全性。方法:选取2016年6月—2017年7月我院收治的消化性溃疡患者116例为研究对象,随机分为观察组与对照组,对照组患者给予奥美拉唑+阿莫西林+西米替丁胶囊,观察组予中满分消汤联用七味胃痛胶囊治疗,对比两组患者临床疗效、幽门螺杆菌(Hp)根除率及治疗前后中医证候积分(烧心、腹痛、嗳气、反酸)、血清炎性因子[肿瘤坏死因子-α(TNF-α)、高敏C反应蛋白(hs-CRP)、白介素-6(IL-6)]水平变化,并观察两组患者不良反应发生率。结果:观察组患者的总有效率显著较对照组升高(P0.05);治疗后,观察组与对照组患者的烧心、腹痛、嗳气、反酸中医证候积分均较治疗前明显下降,且观察组患者烧心、腹痛、嗳气、反酸中医证候积分降低程度高于对照组(P0.05);治疗后,观察组与对照组患者的TNF-α、Hs-CRP、IL-6水平均较治疗前明显降低,且观察组患者TNF-α、Hs-CRP、IL-6水平降低程度高于对照组(P0.05);观察组与对照组患者的Hp根除率分别为86.21%、75.86%,两组对比,观察组患者的Hp根除率显著升高(P0.05);两组患者不良反应发生率无显著差异(P0.05)。结论:中满分消汤联合七味胃痛胶囊治疗消化性溃疡临床疗效显著,且具有较高的安全性,值得临床推广。     

固本清毒汤治疗宫颈高危型人乳头瘤病毒感染临床观察

目的 观察固本清毒汤治疗宫颈高危型人乳头瘤病毒（human papillomavirus, HPV）感染的疗效。方法 将60例宫颈高危型HPV感染患者随机分成治疗组和对照组,每组30例。治疗组予以干扰素片阴道纳药联合固本清毒汤内服,对照组仅予以干扰素片阴道纳药。观察两组患者治疗前后湿热瘀毒证积分变化,检测血清白细胞介素-6（interleukin-6,IL-6）、白细胞介素-8（interleukin-8, IL-8）水平和外周血CD3+、CD4+ T细胞亚群和CD4+/CD8+比值,比较两组中医证候疗效和HPV转阴率。结果 与治疗前比较,两组患者治疗后中医证候积分和血清IL-6、IL-8水平均显著降低（P<0.05）;治疗组中医证候积分和血清IL-6、IL-8水平降低程度显著大于对照组（P<0.05）,治疗组患者中医证候疗效显著优于对照组（P<0.05）。与治疗前比较,对照组患者仅CD3+ T细胞显著升高（P<0.05）,治疗组患者CD3+、CD4+ T细胞和CD4+/CD8+比值均显著升高（P<0.05）。治疗组、对照组患者HPV转阴率分别为83.3%、60%,差异有统计学意义（P<0.05）。结论 固本清毒汤联合干扰素能明显改善宫颈高危型HPV感染患者湿热瘀毒证候,调节机体免疫功能,提高HPV转阴率。     

温肾祛邪法治疗老年反复上呼吸道感染的临床研究

目的 观察温肾祛邪法治疗老年反复上呼吸道感染的临床疗效.方法 选取80例老年反复上呼吸道感染患者,按随机数字表法分为观察组与对照组,各40例.对照组予以抗感染及对症治疗,观察组在对照组基础上联合温肾祛邪法治疗.比较两组临床疗效、治疗前后中医证候积分、T细胞亚群及不良反应总发生率.结果 观察组治疗总有效率为90.0％高于对照组70.0％(P<0.05);观察组治疗后的中医证候主症与次症总评分均低于本组治疗前及对照组治疗后(P<0.05);观察组治疗后的CD4+/CD8+、NK细胞均高于治疗前及对照组治疗后(P<0.05);观察组不良反应与对照组比较无统计学意义(P>0.05).结论 温肾祛邪法治疗老年反复上呼吸道感染可有效增强患者免疫功能,改善患者症状,疗效更佳,再次复发风险小,长期用药副作用少,为理想方案.     

桂芍四妙汤联合苦参凝胶治疗霉菌性阴道炎疗效观察

目的:观察桂芍四妙汤联合苦参凝胶治疗霉菌性阴道炎的临床疗效。方法:将130例霉菌性阴道炎患者按随机数表法分为观察组和对照组,每组65例。对照组采用口服氟康唑胶囊联合外用环吡酮胺阴道栓治疗;观察组采用口服桂芍四妙汤联合外用苦参凝胶治疗,观察两组患者的中医证候疗效、临床疗效、症状消失时间,以及用药后远期复发情况,并记录两组患者的不良反应。结果:治疗后,观察组有效率为95.38%明显高于对照组的87.69%,差异有统计学意义(P0.05);两组患者证候疗效比较,治疗组有效率为98.46%高于对照组的92.30%,差异均有统计学意义(P0.05)。观察组外阴瘙痒消失,白带恢复正常,阴道黏膜充血消失时间均低于对照组,差异有统计学意义(P0.05);两组患者治疗后p H变化比较,差异无统计学意义(P0.05);两组患者经治疗后白细胞介素-6(Interleukin-6,IL-6)、白细胞介素-4(Interleukin-4,IL-4)的含量均低于治疗前,且观察组患者IL-6、IL-4的含量低于对照组,差异均有统计学意义(P0.05)。治疗组不良反应发生率(0%)及复发率(3.07%)明显低于对照组的不良反应发生率(7.68%)及复发率(10.76%),差异均有统计学意义(P0.05)。结论:桂芍四妙汤联合苦参凝胶治疗霉菌性阴道炎疗效显著,且能降低复发率和不良反应。     

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.