基于古今云医案平台分析黄永生教授治疗慢性心力衰竭的用药规律

目的:应用数据挖掘系统古今云医案平台探讨黄永生教授治疗慢性心力衰竭的用药规律。方法:使用古今云医案平台系统,将符合纳入标准的慢性心力衰竭病人原始病例资料进行录入,建立数据库,运用关联规则、中药属性分析等方法对用药、组方等进行分析,总结用药规律。结果:共收集方剂684首,高频药物为砂仁、制附子、炒酸枣仁、丹参、磁石、桂枝、炙甘草、生牡蛎等21味,中药四气以温、平、寒为主;五味以辛、甘、咸、酸为主;归经以脾、肝、胃、心、肾经为主。常用药物组合为僵蚕-水蛭-蝉蜕、黄芪-白术-苍术等。结论:通过古今云医案平台总结黄永生教授治疗慢性心力衰竭的用药规律,即分阶段辨证论治,以益气活血为基础,随着病情发生发展兼具温补心肾阳气及敛阴回阳固脱治其本,利水消肿治其标。     

李军祥教授论治溃疡性结肠炎临床经验“十要”

溃疡性结肠炎(ulcerative colitis,UC)属于炎症性肠病范畴,常累及结直肠黏膜和黏膜下层,以连续性、弥漫性炎症改变为特点,临床以腹泻、黏液脓血便、腹痛和里急后重等为主要症状,具有迁延难愈的特点。部分患者同时可见关节损害、皮肤黏膜病变等肠外表现及并发症,病情复杂[1]。     

联合用药保留灌肠治疗溃疡性结肠炎26例疗效观察

溃疡性结肠炎主要采用内科治疗，其目的是控制急性发作，维持缓解，减少复发，防治并发症。药物治疗常选用氨基水杨酸制剂、糖皮质激素及免疫抑制剂，多采用口服及静脉给药。我们2002-03／2004-01应用联合用药保留灌肠治疗溃疡性结肠炎26例，取得了较好的临床效果，现总结报告如下。     

王长洪教授治疗溃疡性结肠炎的临床经验

溃疡性结肠炎(ulcerative colitis,UC)是临床一种原因不明的,慢性非特异性结肠炎症,病变主要位于结肠黏膜层,以溃疡为主,临床表现主要为腹痛、腹泻及排黏液脓血便,有复发性、难治性的特点,病程长,病情迁延反复.目前西医治疗主要应用肾上腺皮质激素及氨基水杨酸类药物,不良反应较高及治疗费用昂贵等直接影响本病治疗效果.王长洪教授在充分了解西医发病机制及治疗规范基础上,凭借丰富的临床经验,从中医病机人手,将UC临床分期与中医辨证有效结合,采用清热解毒、脾肾同调、化瘀通络的治疗大法,收到良好治疗效果.现将王长洪教授在治疗UC的诊治经验总结如下.     

陈治水教授治疗溃疡性结肠炎临床经验

溃疡性结肠炎（ulcerative colitis，UC）是一种原因未明的结肠非特异性炎性疾病。临床主要表现为腹泻、黏液脓血便、腹痛或里急后重。病情多反复发作，或长期迁延难愈，属于中医学之“肠癖”“泄泻”“痢疾”范畴。陈治水教授擅长治疗胃肠疾病，尤其对UC的治疗每获良效。笔者有幸跟师学习，现将其治疗UC的临床经验总结如下。     

杨倩教授治疗溃疡性结肠炎经验探析

溃疡性结肠炎(ulcerative colitis,UC)是一种慢性、非特异性炎症性肠炎,其主要表现为结肠和直肠的弥漫性黏膜炎症[1]。目前UC的发病机制尚不清楚,一般认为是遗传易感性、肠道菌群失调和免疫失衡共同作用的结果[2]。随着我国经济结构的调整、人民生活方式的改变,UC在我国的发病率逐年增高[3]。作为直结肠癌的危险因素之一,该病严重影响着UC患者的生活质量。5-氨基水杨酸、免疫抑制剂、皮质类固醇和生物制剂是控制UC患者炎症的主要治疗方案。     

李任先教授治疗溃疡性结肠炎经验

溃疡性结肠炎 ,又名非特异性溃疡性结肠炎 ,世界卫生组织称为特发性结肠炎 ,是一种以腹痛、腹泻、粘液便、血便为主要临床表现的非特异性炎症性结肠疾病。本病多发于 2 0岁～ 40岁的青壮年 ,随着饮食结构、生活习惯和生活节奏的改变以及诊断水平的提高 ,近年来中、老年发病有上升趋势。本病病因目前尚不明确 ,国内外文献报道对本病尚无特效疗法 ,且易复发。中医文献虽无溃疡性结肠炎的病名 ,但从其临床症候特点来看 ,当属泄泻、肠风、下血、休息痢、肠癖等病证范畴。李任先教授从事中医临床 40余载 ,治学严谨 ,于溃疡性结肠炎的临证治疗具有…     

溃疡性结肠炎的其他治疗

氨基水杨酸类药物和皮质类固醇类药物目前仍然是治疗溃疡性结肠炎的主要药物,具有起效快,近期临床缓解率高等优点,但停药后易复发,长期用药副反应增多,部分顽固性患者疗效并不理想.中药是我国治疗溃疡性结肠炎的特色,中西医结合治疗是我国的优势,已被广泛应用,也已经取得了一定的效果,但疗效并无根本改善.因此,寻找更为理想有效,副反应少的药物和方法成为溃疡性结肠炎研究的重点.现将除上述治疗以外的其他一些有一定实用价值的药物和方法简单介绍如下:     

溃疡性结肠炎的中医治疗

溃疡性结肠炎(UC)是一种非特异性的炎症性肠病.迄今病因未明.此病属中医"肠癖"、"痢疾"、"滞下"、"肠风"、"脏毒"、"泄泻"等范畴.近年来中医药治疗本病积累了丰富的经验,疗效肯定,显示出独到之处,现归纳综述如下.     

Granulocytapheresis in the treatment of patients with active ulcerative colitis

In recent years, considering the role of inflammatory processes and the involvement of the immune system in ulcerative colitis, granulocytapheresis, a technique for removing circulating leukocytes and preventing their migration into the intestinal mucosa, has been proposed for the treatment of acute ulcerative colitis. Initially introduced for the treatment of patients who did not respond to conventional therapy only, this new therapy may become a useful and safe method to induce clinical remission in patients with acute disease. This article will review the clinical applications and issues concerning the use of granulocytapheresis in ulcerative colitis.     

Surgical and medical treatment in patients with acute severe ulcerative colitis

Ulcerative colitis (UC) is a chronic inflammatory disease of the mucosa of the colorectum. The treatment of UC depends on the severity of symptoms and the extent of the disease. Acute severe colitis (ASC) occurs in 12–25% of patients with UC. Patients with ASC must be managed by a multidisciplinary team. Medically or surgically aggressive treatment is carried out with the final aim of reducing mortality. Intravenous administration of corticosteroids is the mainstay of the therapy. Medical rescue therapy based on cyclosporine or infliximab should be considered if there is no response to corticosteroids for 3 days. If there has been no response to medical rescue therapy after 4–7 days, the patient must undergo colectomy in emergency surgery. Prolonged observation is counterproductive, as over time it increases the risk of toxic megacolon and perforation, with a very high mortality rate. The best potential treatment is subtotal colectomy with ileostomy and preservation of the rectum. Emergency surgery in UC should not be seen as a last chance, but can be considered as a life‐saving procedure. Colectomies in emergency setting are characterized by high morbidity rates but the mortality is low.     

磷酸铝凝胶在溃疡性结肠炎治疗中的应用

[目的]观察磷酸铝凝胶在溃疡性结肠炎治疗中的临床疗效。[方法]选择溃疡性结肠炎患者58例,随机分为磷酸铝凝胶治疗组(治疗组)30例及对照组28例。2组均口服美沙拉嗪片(3次/d,每次2片)的同时给予结肠保留灌肠治疗。对照组的灌肠液为0.9%氯化钠溶液30ml加入地塞米松5mg,治疗组在对照组的灌肠液中再添加磷酸铝凝胶;均1次/d,疗程2周。比较2组临床疗效。[结果]治疗后,治疗组完全缓解例数多于对照组,疾病活动指数低于对照组,腹泻、便血症状改善时间短于对照组,2组比较均差异有统计学意义(P0.05)。[结论]磷酸铝凝胶联合美沙拉嗪片口服对溃疡性结肠炎的疗效显著。     

清化肠饮治疗溃疡性结肠炎大鼠模型的实验性研究

[目的]探索清化肠饮对溃疡性结肠炎（UC）大鼠的治疗作用及其机制.[方法]将60只健康SPF级Wistar大鼠（雌雄各半）,随机分成正常组,模型对照组,清化肠饮高、中、低剂量组和美沙拉秦组.除正常组外,其余各组均采用免疫复合法造模.观察大鼠疾病活动指数（DAI）,ELISA法测定各组大鼠血清TNF-α、IL-6、IL-8及IL-10的变化情况.[结果]治疗前,正常组DAI与各造模组差异均有统计学意义（P＜0.01）;给药2周后,与模型对照组比较,清化肠饮高剂量组、美沙拉秦组大鼠显著降低（P＜0.01）.从大鼠血清上看,与正常组比较,模型对照组大鼠TNF-α、IL-6及IL-8显著增高（P＜0.01）,而IL-10则显著降低（P＜0.01）;与模型对照组比较,清化肠饮高剂量组、美沙拉秦组大鼠TNF-α、IL-6及IL-8显著降低（P＜0.01）,IL-10则显著增高（P＜0.01）;与美沙拉秦组比较,清化肠饮中、低剂量组大鼠TNF-α、IL-6及IL-8显著增高（P＜0.01）,而IL-10则显著降低（P＜0.01）.[结论]高剂量清化肠饮是治疗UC的有效药物,通过调节炎性细胞因子的平衡可能是其作用机制之一.     

Azodisalicylate (Olsalazine) in the treatment of active ulcerative colitis. A placebo controlled clinical trial and assessment of drug disposition

Abstract The efficacy, safety and disposition of azodisalicylate, (ADS, Olsalazine) was assessed in patients with left-sided ulcerative colitis (UC) or proctitis in a double-blind placebo controlled trial. Thirty patients with a mild-to-moderate attack of UC were randomly allocated to ADS capsules 1 g (b.d.) or placebo for 6 weeks; other therapy was ceased. Patients were reviewed weekly and plasma, urine and faecal concentrations of ADS and its metabolites were determined by high performance liquid chromatography (HPLC). Sigmoidoscopy and biopsy were repeated at 6 weeks.
Four patients receiving placebo and two receiving ADS were withdrawn because of diarrhoea. Five patients known to be allergic to sulphasalazine had no adverse reactions to ADS. Good clinical response was found in six patients receiving ADS and in two receiving placebo ( P = 0.11). Improvement in sigmoidoscopic findings and histological appearance of rectal biopsies was also seen more frequently in ADS-treated patients. Plasma concentrations of ADS were significantly higher in patients who improved. Faecal ADS, 5-ASA and acetyl-5-ASA varied widely and showed no correlation with response. ADS showed an advantage over placebo which needs to be confirmed by further studies; it was safe in sulphasalazine-sensitive patients but appeared to cause watery diarrhoea in two patients.     

Sulphasalazine and 5-aminosalicylic acid in long-term treatment of ulcerative colitis: report on tolerance and side-effects

BACKGROUND: Use of sulphasalazine in ulcerative colitis patients is hampered by a variety of side-effects, including male infertility. 5-aminosalicylic acid is better tolerated and has been increasingly used to treat patients intolerant/allergic to sulphasalazine but it may also be associated with side-effects. AIM: To evaluate tolerance of long-term treatment with sulphasalazine and 5-aminosalicylic acid in ulcerative colitis. METHODS: Side-effects to sulphasalazine (2-3 g/day) and 5-aminosalicylic acid (1.2-2.4 g/day) were recorded in 685 patients: 410 patients received only sulphasalazine, 130 only 5-aminosalicylic acid, and 145 both drugs. In patients with side-effects to sulphasalazine, a desensitisation protocol (rechallenge) was attempted to improve tolerance, and patients still presenting side-effects after desensitisation were switched to 5-aminosalicylic acid. Male fertility was also assessed in 42 males on sulphasalazine and on 5-aminosalicylic acid. RESULTS: Side-effects were observed in 110/555 patients (20%) on sulphasalazine and in 18/275 patients (6.5%) on 5-aminosalicylic acid during a median period of follow-up of 7 and 5 years, respectively. Desensitisation was achieved in 40% of patients intolerant to sulphasalazine. 5-aminosalicylic acid intake induced side-effects in 2/130 patients (1.5%) who had not taken sulphasalazine before versus 4/91 patients (4%) tolerating sulphasalazine and 12/54 patients (22%) intolerant/allergic to sulphasalazine, the difference in incidence of side-effects in the two latter groups being statistically significant (4.4% vs 20.8%, p=0. 001). Fertility was found to be affected in all patients on sulphasalazine but improved when put onto 5-aminosalicylic acid. CONCLUSIONS: 5-aminosalicylic acid should be considered the drug of choice in the treatment of ulcerative colitis bearing in mind that intolerance or allergy may occur in a few patients also on this drug.     

基于网络药理学探讨葛根芩连汤治疗溃疡性结肠炎的作用机制

[目的]:运用网络药理学方法对葛根芩连汤治疗溃疡性结肠炎(UC)的作用机制进行研究。[方法]运用TCMSP数据库获取葛根芩连汤有效成分及预测药物作用靶点;运用CTD数据库获取UC疾病基因;运用STRING在线工具构建蛋白互相作用网络;使用Cytoscape 3.7.1软件进行蛋白网络可视化处理,运用cytoHubba、MCODE插件筛选关键基因;使用WebGestalt工具进行基因本体及KEGG信号通路分析。[结果]葛根芩连汤靶点与UC疾病的交集基因共112个,功能涉及细胞增殖、细胞凋亡、蛋白质磷酸化、细胞膜、转录因子等方面;KEGG信号通路结果显示交集基因富集于免疫调节密切相关的Th17细胞分化、IL-17信号、肿瘤坏死因子信号通路、与缺氧相关的低氧诱导因子-1信号通路、肿瘤相关的癌症的途径、结直肠癌通路和PI3K-Akt信号通路;筛选得共10个关键靶点基因,这些基因与免疫反应、肿瘤密切相关。[结论]葛根芩连汤治疗UC的机制是多靶点、多通路的复杂过程,其机制与调节免疫反应、缺氧反应、抗肿瘤等相关通路有关。     

Role of surgery in severe ulcerative colitis in the era of medical rescue therapy

Despite the growing use of medical salvage therapy, colectomy has remained a cornerstone in managing acute severe ulcerative colitis (ASC) both in children and in adults. Colectomy should be regarded as a life saving procedure in ASC, and must be seriously considered in any steroid-refractory patient. However, colectomy is not a cure for the disease but rather the substitution of a large problem with smaller problems, including fecal incontinence, pouchitis, irritable pouch syndrome, cuffitis, anastomotic ulcer and stenosis, missed or de-novo Crohn's disease and, in young females, reduced fecundity. This notion has led to the widespread practice of offering medical salvage therapy before colectomy in most patients without surgical abdomen or toxic megacolon. Medical salvage therapies which have proved effective in the clinical trial setting include cyclosporine, tacrolimus and infliximab, which seem equally effective in the short term. Validated predictive rules can identify a subset of patients who will eventually fail corticosteroid therapy after only 3-5 d of steroid therapy with an accuracy of 85%-95%. This accuracy is sufficiently high for initiating medical therapy, but usually not colectomy, early in the admission without delaying colectomy if required. This approach has reduced the colectomy rate in ASC from 30%-70% in the past to 10%-20% nowadays, and the mortality rate from over 70% in the 1930s to about 1%. In general, restorative proctocolectomy (ileoanal pouch or ileal pouch-anal anastomosis), especially the J-pouch, is preferred over straight pull-through (ileo-anal) or ileo-rectal anastomosis, which may still be considered in young females concerned about infertility. Colectomy in the acute severe colitis setting, is usually performed in three steps due to the severity of the inflammation, concurrent steroid treatment and the generally reduced clinical condition. The first surgical step involves colectomy and constructing an ileal stoma, the second - constructing the pouch and the third - closing the stoma. This review focuses on the role of surgical treatment in ulcerative colitis in the era of medical rescue therapy.