老年2型糖尿病干眼症应用七叶洋地黄双苷滴眼液治疗的疗效分析

目的分析老年2型糖尿病干眼症应用七叶洋地黄双苷滴眼液治疗的临床疗效。方法抽选64例于该院接受治疗的老年2型糖尿病干眼症患者,将其平均分成观察组与对照组后,分别给予其七叶洋地黄双苷滴眼液与泪然滴眼液进行临床治疗。比较两组患者治疗前后的各项临床指标与总有效率。结果治疗结束后,观察组患者的BUT、SIt、SAI以及SRI各项临床指标改善程度均大于对照组;观察组患者的治疗总有效率(93.75%)明显高于对照组的对应值(71.88%)(P0.05)。结论给予老年2型糖尿病干眼症患者应用七叶洋地黄双苷滴眼液进行临床治疗,不仅有利于改善其各项临床指标,更能够显著提高患者的治疗效率,具有较高的推广、应用价值。     

施图伦滴眼液治疗干眼症伴发视疲劳有效性及安全性的临床观察

目的临床观察施图伦滴眼液治疗干眼症伴发视疲劳的有效性和安全性。方法应用施图伦滴眼液治疗30例干眼症伴发视疲劳患者,分别于治疗前和治疗4周后观察记录分析患者的不适症状、视力、屈光度及不良反应情况。结果与治疗前比较,治疗后不适症状总评分明显改善,头疼、恶心呕吐、眩晕三项指标无明显改善,其余各项不适症状指标均有明显好转。双眼裸眼视力及屈光度元明显变化。结论施图伦滴眼液治疗干眼症伴发视疲劳是安全有效的。     

杞菊地黄丸联合聚乙二醇滴眼液治疗2型糖尿病患者干眼症的临床观察

目的观察杞菊地黄丸联合聚乙二醇滴眼液点眼与单纯应用聚乙二醇滴眼液治疗2型糖尿病患者的干眼症的治疗效果。方法将2017年3—12月已经确定患有2型糖尿病患者,同时符合干眼症诊断标准的50例患者,随机分为联合组和对照组,各25例50眼。联合组采用口服杞菊地黄丸和局部滴用聚乙二醇(思然)滴眼液;对照组采用单纯滴用聚乙二醇(思然)滴眼液。根据临床症状和基础泪液分泌试验、泪膜破裂时间、角膜荧光素钠染色等检查进行评分,治疗观察3个月。结果两组不同方法治疗后,BUT,SIt,FL 3项指标与治疗前比较,差异有统计学意义(P0.05),且治疗后联合组上述实验结果明显高于对照组(P0.01);联合药物治疗组有效率96%,单纯药物治疗组总有效率64%,联合组疗效明显优于对照组(P0.01)。结论杞菊地黄丸联合聚乙二醇滴眼液局部点眼治疗2型糖尿病的患者干眼症疗效较单纯使用聚乙二醇液滴眼疗效好。     

不同药物治疗白内障超声乳化术后干眼症的临床效果

目的对比分析玻璃酸钠和羧甲基纤维素钠滴眼液治疗白内障超声乳化术后干眼症的临床疗效。方法随机抽取于2016年1月至2016年12月时间段内笔者所在医院进行治疗的白内障超声乳化术后干眼症患者80例,以国际随机数字表法分为观察组和对照组,各40例患者。两组患者均行超声乳化术进行治疗,观察组患者术后给予羧甲基纤维素钠滴眼液滴眼,对照组患者给予玻璃酸钠滴眼液滴眼。结果观察组患者临床治疗总有效率,明显比对照组高,差异显著P0.05。观察组患者术后1周、4周、12周时的干眼症状评分、角膜荧光染色评分,都明显比对照组低,BUT评分明显比对照组高,差异显著P0.05。结论与玻璃酸钠滴眼液相比,羧甲基纤维素钠滴眼液治疗白内障超声乳化术后干眼症,可显著改善患者的干眼症状,提高患者的术后视觉质量,可对白内障超声乳化术后干眼症起到良好的临床治疗效果。     

中草药及其提取物治疗干眼症

目的探讨中草药及其提取物治疗干眼症患者的临床疗效。方法 100例(200眼)干眼症患者作为研究对象,随机分成对照组与研究组,每组50例(100眼),对照组采用玻璃酸钠滴眼液滴眼治疗,研究组采用中药联合玻璃酸钠滴眼液滴眼治疗。观察并比较两组临床疗效、不良反应情况及治疗前后视功能影响。结果研究组治疗后总有效率显著高于对照组(P0.05);两组治疗后视功能评分均高于治疗前,且研究组治疗后视功能评分显著高于对照组(P0.05);研究组不良反应总发生率低于对照组,但差异无统计学意义(P0.05)。结论中草药治疗干眼症患者可显著提高临床疗效,改善视功能,且无明显不良反应,因此中草药及提取物在治疗干眼症方面有着举足轻重的作用。     

托伐普坦对老年慢性心力衰竭患者的疗效及对心容量负荷、血清炎症因子的影响

目的:观察托伐普坦治疗老年慢性心力衰竭(CHF)患者的临床疗效及对心容量负荷、血清炎症因子的影响。方法:将130例老年CHF患者分为对照组与观察组,对照组给予常规治疗,观察组在对照组的基础上给予托伐普坦治疗。观察2组患者治疗前及治疗3个月后心容量负荷指标、血清炎性因子表达水平、心功能指标及血清钠水平的变化情况,并评估其临床疗效。结果:2组临床疗效比较,差异有统计学意义(P0.05);治疗后,2组患者心容量负荷指标、血清炎症因子与心功能指标均较治疗前改善(均P0.05),且观察组各项指标均优于对照组(均P0.05);治疗后,观察组患者血清钠水平较治疗前升高(P0.05),对照组较治疗前降低(P0.05),观察组患者血清钠水平高于对照组(P0.05)。结论:托伐普坦可提高老年CHF患者的临床疗效,降低患者心容量负荷,预防低钠血症,抑制血清炎症因子过高表达。     

托伐普坦对于慢性心衰老年患者的临床疗效的影响

目的：观察托伐普坦治疗慢性心力衰竭（心衰）老年患者的临床疗效及对患者心容量负荷、血清炎症因子的影响。方法：选取本院2015年1月～2018年1月间收治的130例慢性心力衰竭老年患者纳入本次研究,将入选患者均分为对照组与观察组,对照组给予常规治疗,观察组在对照组的基础上给予托伐普坦进行治疗,以3个月为一疗程;治疗一疗程后,评估两组临床疗效,观察两组患者治疗前、后心容量负荷指标、血清炎性因子表达水平、心功能指标及血清钠水平的变化情况。结果：观察组临床疗效较对照组理想,P<0.05;治疗后,两组患者心容量负荷指标、血清炎症因子与心功能指标均较治疗前改善P<0.05,但观察组各项指标均优于对照组,P<0.05;治疗后,观察组患者血清钠水平较治疗前提高P<0.05,对照组患者血清钠水平较治疗前降低P<0.05,观察组患者血清钠水平高于对照组P<0.05。结论：托伐普坦可提高慢性心衰老年患者的临床疗效,降低患者心容量负荷,预防低钠血症,抑制血清炎症因子过高表达。     

基于40例2型糖尿病患者的干眼症并发因素分析

目的分析2型糖尿病患者干眼症的并发因素。方法回顾性分析该院眼科门诊2017年6月—2018年8月收治的40例(80眼)2型糖尿病患者(观察组),另选取同期入院就诊的40例(80眼)非糖尿病患者(对照组),调查两组研究对象的干眼自觉症状,并对两组研究对象进行常规的眼部检查以及干眼症特异性检查,对比分析干眼症发生的影响因素。结果观察组自觉干眼症发生率、SIt、BUT、FL指标与对照组相比差异有统计学意义(P0.05),观察组有干眼症组的病程与糖化血红蛋白与无干眼症组对比差异有统计学意义(P0.05),但观察组的有无干眼症两组的空腹血糖水平对比差异无统计学意义(P0.05)。结论糖尿病患者干眼症发生与血糖控制不佳、泪膜功能变化以及病程相关,临床应高度重视这些危险诱因,积极预防降低糖尿病干眼症发生率。     

自体骨髓单个核细胞移植治疗糖尿病下肢血管病变疗效及其与血清肝细胞生长因子的关系

目的探讨自体骨髓单个核细胞移植治疗糖尿病下肢血管病变的疗效及其与血清肝细胞生长因子(HGF)水平的关系。方法选择2006年6月至2009年6月沈阳市第七人民医院79例糖尿病下肢血管病变患者,分为常规治疗组(A组,40例,80条患肢)和自体骨髓单个核细胞移植治疗组(B组,39例,78条患肢),治疗6个月后对疗效及其与血清HGF关系进行评估。结果(1)B组治疗后1周肢体疼痛、患肢冷感、皮肤温度、血清HGF与B组治疗前及A组治疗后1周比较差异有统计学意义(P0.05),并与血清HGF存在相关性(P0.05)。(2)B组治疗后3个月、6个月各项临床观察指标与B组治疗前及A组治疗后相同时间点比较差异均有统计学意义(P0.05)。结论自体骨髓单个核细胞移植技术治疗糖尿病下肢血管病变可以提高疗效,不会导致由于血清HGF长期增高引起的副反应。     

环孢霉素A联合左旋咪唑治疗干眼症108例疗效观察

干眼症的病因复杂且多样化，主要症状为眼干燥、异物感及烧灼感等，有些患者出现视力下降，荧光素染色角膜下部或上下睑之间经常有点状着染，临床治疗效果较差。2000年1月-2006年5月，我院采用环孢霉素A（CSA）滴眼液联合左旋咪唑搽剂治疗干眼症患者108例，效果满意。现报告如下。     

Autologous serum eye drops for the treatment of severe dry eye in patients with chronic graft-versus-host disease

We investigated the efficacy and safety of autologous serum eye drops for the treatment of severe dry eye after allogeneic haematopoietic stem cell transplantation (SCT). A total of 14 patients (four males and 10 females; median age, 31.0 years) with severe dry eye associated with chronic graft-versus-host disease (cGVHD) were enrolled in this study. All patients were refractory to treatment with conventional artificial tears. Autologous serum eye drops, a solution made of 20% autologous serum in sterile saline, were applied 10 times per eye per day. The patients were evaluated every 4 weeks according to visual acuity, corneal sensitivity, vital staining of the ocular surface, tear dynamics, and subjective assessments of symptoms (complaints scores). The median follow-up period was 19.4 months (range: 4-41 months). After 4 weeks of treatment, significant improvement was observed in both complaint scores (from 33.7+/-12.3 to 23.6+/-10.6 points; P<0.01) and fluorescein scores (from 5.8+/-2.0 to 2.4+/-0.9 points; P<0.005). Significant improvements were observed also in rose-bengal staining and tear break-up time. In seven of the 14 patients, the responses were maintained for 6-41 months (median:19.4+/-8.3 months), while six of the other seven patients required treatment with punctal plugs in addition to autologous serum eye drops. One of these other seven patients developed eczema around the eyelids, after which the treatment was discontinued. No serious adverse events were observed. We conclude that autologous serum eye drops are safe and effective for treating severe dry eye associated with cGVHD and that more efficient control of dry eye may be achieved by the combined use of autologous serum eye drops with punctal plugs.     

Dry eye: Diagnosis and current treatment strategies

One in four patients attending ophthalmic clinics report symptoms of dry eye, making it one of the most common complaints seen by ophthalmologists. Aqueous-layer deficiency is the most common form of dry eye and is frequently caused by decreased secretion of tears by the lacrimal glands. Evaporative dry eye is often secondary to meibomian gland disease and results in a defective lipid layer. Tear replacement or preservation using artificial tears and/or punctal occlusion are the mainstay of treatment. Newer forms of therapy were designed to modify the underlying disease process. These include the use of topical cyclosporin A, autologous serum, and sodium hyaluronate drops, which suppress underlying inflammation, provide growth factors, and prevent the onset of squamous metaplasia in ocular surface epithelium. Hormonal therapy might have a role in the future of dry eye therapy.     

Risk factors and characteristics of ocular complications, and efficacy of autologous serum tears after haematopoietic progenitor cell transplantation

The objective of the study was to evaluate the frequency and clinical characteristics of ocular complications and their risk factors, as well as autologous serum tears (AST) for the treatment of dry eye in these patients. Data from the files of 124 patients who had undergone allogeneic haematopoietic progenitor cell transplantation (HPCT) were evaluated. In addition, 33 HPCT patients were examined and their data were compared with controls. Analysis of tears and AST was performed. Dry eye manifestation occurred in 32% of patients and was positively correlated with age over 27 years (P = 0.05), peripheral blood progenitor cell transplant (P = 0.002), chronic graft-versus-host disease (P = 0.0027), and chronic or acute myeloid leukaemia (P = 0.001). Dry mouth and Schirmer test < 5 mm were predictive factors for dry eye in HPCT patients (P = 0.002 and odds ratio 3.9 and P = 0.007, odds ratio = 5.9, respectively). Microbiological analysis revealed that six of 11 AST samples were contaminated after 30 days of use. The present study supports the role of potential risk factors for ocular complications and key elements to detect alterations in the tear film from HPCT patients. In addition, AST contamination must be considered after longer periods of use.     

Therapeutic effect of umbilical cord serum eyedrops for the treatment of dry eye associated with graft-versus-host disease

This study was performed to investigate the therapeutic effect of umbilical cord serum eyedrops on dry eye associated with graft-versus-host disease (GVHD). Twenty-four eyes of 12 patients with severe dry eye syndrome associated with GVHD were treated with 20% umbilical cord serum eyedrops. Symptom scoring, corneal sensitivity test, tear film break up time (BUT), Schirmer test, tear clearance rate (TCR), and corneal fluorescein staining were performed before and 2 and 6 months after treatment. Six months after treatment, significant improvement was observed in symptom score (from 3.83+/-0.38 to 0.83+/-0.57, P<0.01), corneal sensitivity (from 52.08+/-6.06 mm to 57.50+/-3.00 mm, P<0.01), tear film BUT (from 2.50+/-0.91 s to 5.71+/-1.04 s, P<0.01), and keratoepitheliopathy score (from 7.42+/-2.02 to 1.29+/-0.46, P<0.01). There was no siginificant change in Schirmer test and TCR results. No significant complications associated with the use of the eyedrops were observed. Umbilical cord serum eyedrops are safe and may be an effective way to treat severe dry eye associated with GVHD.     

Recent advances in the management of ocular complications of sjögren’s syndrome

Sjögren’s syndrome (SS) is an autoimmune disorder, the principal ocular manifestation of which is decreased tear production leading to chronic irritation and damage to the corneal and conjunctival epithelium. The most important advance in the treatment of ocular manifestations of SS is the introduction of topical anti-inflammatory agents such as cyclosporine A, which increases tear production and decreases symptoms without any significant side effect. Stimulators of tear secretion, both topical, such as diquafosol, and systemic, such as pilocarpine and cevimeline, are also effective, although they have been associated with frequent side effects. Topical use of autologous serum is another new and effective form of treatment, but problems in the preparations prevent their widespread use. Additionally, nonpharmacologic treatments, such as insertion of punctal plugs, are beneficial in the dry eye of SS, whereas several other modalities, such as anti-CD4 monoclonal antibody eye drops and gene transfer, are still in experimental phases.     

The clinical effects of sodium hyaluronate,polyethylene glycol,and dextran-70 eye drops in relieving dry eye after phacoemulsification

To compare the clinical efficacy of sodium hyaluronate eye drops, polyethylene glycol eye drops, and compound dextran eye drops in the treatment of dry eye after phacoemulsification of cataract.A total of 99 patients with dry eye after cataract phacoemulsification combined with intraocular lens implantation were treated in our hospital. Patients were divided into group A (sodium hyaluronate eye drops), group B (polyethylene glycol eye drops), and group C (dextran-70 eye drops). The clinical effect, tear film breakup time, basic tear secretion, corneal staining score, dry eye symptom score, and the incidence of ocular irritation were assessed.On the 3rd, 15th, 30th, and 60th day after operation, the tear film breakup time, corneal staining score, Schirmer I test, and dry eye symptom score in group A and group B were better than those in group C (P < .05). In addition, there were no significant differences in tear breakdown time, corneal staining score, Schirmer I test, and dry eye symptom score between group A and group B (P > .05). At 3 days to 60 days after operation, the incidence of dry eye in group A (12.12%) and group B (18.18%) was lower than that in group C (39.39%), and the incidence of dry eye in group A was significantly lower than that in group B (P < .05).The effect of sodium hyaluronate eye drops elicited a greater beneficial impact as compared to polyethylene glycol eye drops and dextran-70 eye drops.     

Testosterone reduces complement sensitivity of precursor cells in aplastic anaemia patients treated with antilymphocyte globulin

Of 53 consecutive patients with aplastic anaemia who were re-examined at various intervals after treatment with antilymphocyte globulin, 30 had sufficient bone marrow colony forming capacity to permit evaluation of androgen effects in vitro. In 22 patients, precursor cells of the myeloid and erythroid line were abnormally sensitive to a preincubation in isosmolar sucrose with 5% fresh autologous serum compared to heat-inactivated autologous serum. This phenomenon was interpreted as excess complement sensitivity. This inhibitory effect of fresh serum in the bone marrow sucrose test was abrogated by addition of 10(-6) M testosterone to the preincubation phase in 15 of the 22 patients. In six of these 15, 10(-7) M dexamethasone had a similar effect; in the other nine patients only testosterone rendered the bone marrow sucrose test negative. This effect of testosterone on colony growth was indirect, since addition of 10(-9)-10(-5) M testosterone to primary bone marrow cultures from the same patients had no effect. We propose that testosterone in these experiments interacted with the complement system. In patients who have complement sensitive precursor cells, androgens might thus prevent complement mediated lysis of haemopoietic cells to some extent. The test described could help identification of patients in autologous bone marrow remission who are likely to benefit from androgen treatment.     

Comparison between sensitivity of autologous skin serum test and autologous plasma skin test in patients with Chronic Idiopathic Urticaria for detection of antibody against IgE or IgE receptor (FcεRIα)

Intradermal injection of autologous serum and plasma elicit a cutaneous reactivity in almost 45-60% of patients with Chronic Idiopathic Urticaria (CIU). This reactivity is associated with the presence of auto antibodies against IgE or IgE receptors. This study was carried out to compare the cutaneous reactivity of autologous serum and plasma skin tests in a series of patients with CIU for diagnosis of auto antibodies against IgE or IgE receptor. Fifty eight patients with CIU were injected intradermally with autologous serum and plasma (anticoagulated by citrate). Histamine was used as positive control and normal saline as negative control. The study group was checked by routine laboratory tests (CBC, U/A etc), allergens with skin prick tests, and serum IgE level, and auto antibodies against thyroid as well. Duration of urticaria was another factor which was assessed.There was no significant difference between positive ASST and positive APST patients for the above mentioned tests. 77.6% of the patients were Positive for APST and 65.5% were ASST positive. Duration of urticaria was longer in patients with positive ASST and APST than ASST and APST negative patients, although the difference was not statistically significant.Autologus serum skin test (ASST) and autologous plasma skin test (APST) could be used for estimation of duration and severity of urticaria and planning for the treatment.     

Chronic autoreactive urticaria at six years of age.

A case of chronic urticaria in a child 6 years old is described. The strong skin reactivity upon intradermal injection of autologous serum suggested an autoreactive pathogenesis; however, patient's serum was unable to induce histamine release from basophils in-vitro, indicating the presence of a histamine-releasing factor specific for mast cells, and possibly other than an anti-FcepsilonRI or anti-IgE antibody. Intradermal test with autologous serum may be useful in revealing the autoreactive nature of chronic urticaria and can avoid a frustrating search for other causes of the disease. In children presenting with chronic or recurrent urticaria the diagnostic workup should include the autologous serum skin test.     

乏力、口干,间断肢体麻木,双肾多发结石

38岁女性患者,临床表现为口干眼干、低钾高氯性酸中毒伴双肾多发结石,病程中反复出现肢体麻木伴视野缺失,结合唇黏膜活检及相关检查确诊为干燥综合征、干燥综合征所致的远端肾小管酸中毒和中枢神经系统病变。给予积极的免疫抑制治疗,随访10年,SSA抗体转为阳性,肾小管功能改善,血清肌酐持续正常,神经系统病变无明显进展。