慢性乙型肝炎肝纤维化辨证分型与肝纤维化病理及血清学指标的相关性研究

目的:探讨慢性乙型肝炎(CHB)肝纤维化证型分布与血清肝纤维化指标及肝纤维化病理分期的相关性.方法:对确诊的171例CHB肝纤维化患者进行辨证分型,并观察肝纤维化病理分期、肝纤维化4项与辨证分型的关系.结果:肝郁脾虚型主要见于在肝纤维化早期(S1),瘀血阻络型主要见于肝纤维化中晚期(S3～S4),两者比较,各病理期的分布有显著性差异(P＜0.01);脾肾阳虚型、瘀血阻络型HA含量显著高于肝郁脾虚型,差异有显著性意义(P＜0.05或P＜0.01);瘀血阻络型HA含量高于肝肾阴虚型和湿热中阻型,差异有显著性意义(P＜0.05);瘀血阻络组LN和Ⅳ-C含量明显高于肝郁脾虚型,差异有显著性意义(P＜0.05);各证型患者血清PCⅢ含量差异无显著性意义(P＞0.05).结论:CHB肝纤维化不同病理阶段,证型分布发生相应变化,并与肝纤维化指标具有显著相关性.     

594例轻度慢性乙型肝炎中医证候分布规律调查研究

目的:探讨轻度慢性乙型肝炎(CHB)患者的中医证候分布规律,为规范化治疗CHB提供参考依据.方法:运用中医证候量表对594例轻度CHB患者进行中医证候调查,采用聚类分析的方法对纳入的患者进行聚类,并结合变量频数分析对证型归属进行判定.结果:收集的轻度CHB病例均以肝郁脾虚为主要证型,在此基础上合并有6个兼证,分别为肝郁脾虚兼湿热阴虚血瘀证型(62.80％)、肝郁脾虚兼肝肾阴虚证型(24.24％)、肝郁脾虚兼肝郁化火证型(5.05％)、肝郁脾虚兼肝胃不和证型(3.70％)、肝郁脾虚兼中气亏虚证型(2.53％)和肝郁脾虚兼瘀血阻络证型(1.68％).肝郁脾虚兼湿热阴虚血瘀证型又进一步分为5个亚型,分别为脾虚为主型(45.30％)、普通型(22.52％)、气滞为主型(17.70％)、湿热为主型(10.46％)、肾虚为主型(4.02％).结论:肝都脾虚证型为轻度CHB的基本证型.     

FIB-4指数对慢性乙型肝炎肝郁脾虚证和湿热中阻证患者肝纤维化的诊断价值

目的:探讨FIB-4指数对慢性乙型肝炎(CHB)肝郁脾虚证和湿热中阻证患者肝纤维化的诊断价值,为中医辨证施治提供依据。方法:对143例CHB肝郁脾虚证患者和湿热中阻证患者抽血进行谷丙转氨酶(ALT)、谷草转氨酶(AST)、血小板(PLT)的检测及肝穿刺活检,结合患者年龄,根据FIB-4计算公式得出FIB-4指数,对肝活检病理进行GS分期,以肝穿刺病理为金标准绘制出FIB-4指数的受试者工作特征曲线(ROC),计算曲线下面积,评价其对CHB肝郁脾虚证和湿热中阻证患者肝纤维化的诊断价值。结果:CHB肝郁脾虚证和湿热中阻证患者的FIB-4指数与肝纤维化程度呈正比(P0.001)。结论:FIB-4指数是简单有效的无创肝纤维化诊断方法,能一定程度上避免肝穿刺,CHB湿热中阻证患者肝纤维化程度较肝郁脾虚证患者的肝纤维化程度高。     

慢性乙型肝炎患者舌脉象参数特征分析

目的分析慢性乙型肝炎(CHB)患者舌脉象参数变化特征,为CHB患者中医临床辨证提供量化的客观依据。方法应用DS01-A型舌脉象数字分析仪检测120例CHB患者舌脉象参数,分析其舌脉象参数特征。结果与45例健康对照组比,CHB患者脉象参数h3/h1、h4/h1、W/t升高,h5/h1下降,差异有统计学意义(P0.05);湿热中阻组患者h3/h1和h4/h1高于肝肾阴虚组患者(P0.05),肝郁脾虚组h3/h1高于肝肾阴虚组(P0.05);与健康对照组比较,CHB患者舌象参数R、G、B、V值下降,S值升高,差异有统计学意义(P0.05);湿热中阻、肝郁脾虚和肝肾阴虚组R值均高于瘀血阻络组(P0.05),B值均低于瘀血阻络组(P0.05);湿热中阻和肝郁脾虚组S值低于瘀血阻络组(P0.05);肝肾阴虚组B值高于湿热中阻组(P0.05)。结论检测舌脉象参数变化可以反映CHB患者舌脉象变化规律,为CHB患者中医临床辨证提供量化的客观依据。     

慢性乙型肝炎患者中医证型与肝组织病理、肝内Ⅳ型胶原免疫组化及血清肝纤维化指标的关系

目的:探讨慢性乙型肝炎(CHB)患者中医证型与肝组织病理、肝内Ⅳ型胶原(CⅣ)及血清Ⅲ型前胶原(PCⅢ)、透明质酸(HA)、CⅣ同步检测的相关性及对肝纤维化的诊断意义.方法:104例CHB患者进行中医辨证分型、肝组织病理学、肝内CⅣ免疫组化及血清PCⅢ、HA、CⅣ的检测.结果:①病理学诊断属CHB轻度者74例,中度21例,重度9例;②中医辨证分型:属肝郁脾虚型56例(53.88%)、肝胆湿热型3例(2.85%)、肝肾阴虚型14例(13.46%)、脾肾阳虚型5例(4.81%)及瘀血阻络型26例(25.00%);③CHB轻度组,中医辨证以肝郁脾虚型为主,占71.62%(53/74);中度组以瘀血阻络型为主,占66.66%(14/21);重度组病例均属瘀血阻络型.④依中医证型肝内CⅣ免疫组化检测,瘀血阻络型肝内CⅣ检测值显著高于其他各型(P＜0.01);⑤血清PCⅢ、HA与CⅣ检测值瘀血阻络型均显著高于其他各型(P＜0.01);⑥肝内CⅣ检测值与血清PCⅢ、HA和CⅣ检测值比较,呈明显正相关性(r值分别为0.995,0.993,0.984;均P＜0.01).结论:CHB患者肝组织病理、肝内CⅣ免疫组化及血清PCⅢ、HA、CⅣ同步检测与中医证型间有显著相关性,对指导CHB患者肝纤维化的诊断与治疗具有重要临床意义.     

慢性病毒性肝炎279例病理诊断与中医证型的关系

目的:探讨慢性病毒性肝炎病理组织学诊断与中医辨证分型之间的关系,为中医辨证提供客观依据。方法:279例均为住院患者,男227例,女52例。全部病例经肝活检证实,其中轻度142例,中度91例,重度46例。慢性乙型肝炎274例,慢性丙型肝炎5例。中医辨证:湿热中阻53例,肝郁脾虚64例,肝肾阴虚29例,脾肾阳虚7例,血瘀血热101例,气阴两虚25例。临床治疗以辨证施治为主。结果:(1)279例慢性肝炎在病理诊断分型中,轻度占50.9%、中度占32.6％、重度占16.4％。(2)在轻度慢性肝炎中,湿热中阻、肝郁脾虚及肝肾阴虚证明显高于血瘀血热证.P=0.01、P<0.05。(3)湿热中阻、肝郁脾虚证的病理诊断分布情况依次为轻度>中度>重度,P<0.01、P<0.05;血瘀血热证轻度与中度分别>重度,P<0.05。但该证在重度中的发生率高于其他证型。(4)脾肾阳虚与气阴两虚证在各病理分型中的分布均无显著差异,P>0.05。结论:(1)慢性肝炎患者以轻度居多,占半数以上。(2)慢性肝病的病变早期以湿热中阻、肝郁脾虚为主证特点,病变部位多在气分;随着肝脏病理损害加重,病变部位及主导证型渐由气分至血分,以血瘀血热为主证特点。(3)治疗上主张早期宜注重清解湿热,疏肝健脾;中、晚期宜重视活血化瘀,凉血解毒。     

健脾为主辨证治疗对慢性乙型肝炎患者外周血树突状细胞表型功能的影响

目的:研究健脾为主辨证治疗对脾虚为主不同中医证候类型慢性乙型肝炎(CHB)患者,外周血树突状细胞(DC)表型、功能的影响.方法:CHB患者60例,中医诊断符合脾虚肝郁、脾虚湿热、脾肾两虚等证候,每组20例,10名健康人为正常对照组.分离各组外周血单个核细胞,体外诱导培养DC;流式细胞仪测定DC表型;ELISA法测定DC分泌IL-10含量;同步检测患者生化指标及HBV DNA水平;各组患者分别予健脾法为主的中药辨证治疗,疗程为3个月,治疗结束后重复指标检测.结果:CHB患者DC体外诱导增殖能力较正常人下降,DC成熟表面标记物显著低于正常人(P＜0.05);不同中医证候类型患者DC表面标记物表达水平存在差异;其中脾虚肝郁组CD8O、CD1a、HLA-DR表达阳性率显著高于脾肾两虚组(P＜0.05);CHB患者DC培养上清液中IL-10含量显著高于正常人(P＜0.05),脾肾两虚组DC培养上清液中IL-10含量显著高于中脾虚肝郁组(P＜0.05).治疗后各组DC成熟度及分泌功能均有不同程度改善,其中脾虚肝郁组CD80、CD86、CD1a表达率较治疗前显著提高(P＜0.05),脾虚湿热组、脾肾两虚组CD80、CD86、CD1a、HLA-DB表达率较治疗前显著提高,而IL-10含量显著降低(P＜0.05);治疗后除脾虚湿热组CD80表达高于脾肾两虚组外,各型DC表面标记物与IL-10比较,差异无显著性意义.结论:在CHB发病过程中,脾虚为主不同中医证候患者DC的表型及功能低下并存在差异,中药辨证治疗可改善DC表型及功能.     

辅助性T细胞17/调节性T细胞与慢性乙型肝炎中医辨证分型的关系及意义

目的:观察Th17/Treg在慢性乙型肝炎(CHB)中医不同证型中的变化。方法:90例CHB患者按中医辨证分为湿热中阻型、肝郁脾虚型、肝肾阴虚型、脾肾阳虚型、瘀血阻络型,同时选择健康志愿者30例,流式细胞术测定辅助性T淋巴细胞17(Th17)、调节性T(Treg)细胞水平。结果:CHB组与健康对照组Th17细胞、Treg细胞、Th17/Treg比值比较差异有统计学意义(均P<0.05);湿热中阻型、肝郁脾虚型患者ALT水平、Th17细胞、Treg细胞、Th17/Treg比值与其他3种证型比较,差异有统计学意义(均P<0.05);瘀血阻络型、肝肾阴虚型、脾肾阳虚型,3组患者ALT水平、Th17细胞、Treg细胞、Th17/Treg比值差异均无统计学意义(均P>0.05)。结论:Th17/Treg在HBV感染中存在失衡,CHB中医不同证型中均存在Th17/Treg失衡,以湿热中阻型、肝郁脾虚型尤为明显,并与ALT水平相关。     

比较不同量表评价心力衰竭与非心力衰竭患者焦虑/抑郁的初步研究

目的:比较不同自评量表评价心力衰竭(HF)与非心力衰竭(NHF)心脏病患者焦虑/抑郁发生情况的研究.方法:前瞻性截面研究.入选HF与NHF的住院患者患者256例,分组填写Zung氏焦虑/抑郁自评量表(SAS/SDS)或医院焦虑抑郁自评量表(I-IADS),评价:①HF与NHF焦虑/抑郁的发生情况;①比较两种量表评价的敏感性和特异性.结果:①两种自评量表的评定结果,HF与NHF患者的焦虑抑郁发生率分别为32.5%和20.0%(P=0.022),31.7%和16.9%(P:0.006),而且HF患者的焦虑/抑郁发生率与NYHA分级正相关,相对危险度=1.929或=2.283;①HADS的敏感性显著高于SAS/SDS(P<0.05),后者的特异性显著高于前者(P<0.05).结论:①HF患者的焦虑/抑郁发生率比NHF患者高;②HADS适用于临床筛查,而SAS/SDS则适用于临床诊断.     

中老年类风湿关节炎患者负面情绪与生活质量的相关性

目的探讨中老年类风湿关节炎(RA)患者负面情绪与生活质量的相关性。方法选取156例中老年RA患者,采用焦虑自评量表(SAS)和抑郁自评量表(SDS)进行心理评定,36条项目简明量表(SF-36)进行生活质量评定,视觉模拟评分法(VAS)对患者进行病情评估,spearman相关分析方法分析老年RA患者生活质量与负面情绪的关系。结果 156例RA中,SAS标准分为(47.12±7.35),有焦虑症状者51例(32.69%);SDS标准分为(52.83±8.12),有抑郁症状者79例(50.64%),其中轻度抑郁44例(28.21%),中度抑郁29例(18.59%),重度抑郁6例(3.85%);同时有焦虑、抑郁症状者29例(18.59%);与国内常模组标准分比较,RA患者SAS、SDS评分显著增高(P0.05)。SAS、SDS标准分均与疼痛、睡眠、饮食和疲劳四项VAS指标评分呈正相关(P0.05);与生理功能、身体疼痛、活力、总体健康、精神健康、健康变化呈正相关(P0.05),而与生理职能、社会功能、情感职能无关(P0.05)。结论中老年RA患者大多存在不同程度的焦虑、抑郁负性情绪,且与类风湿病情及生活质量有关。通过改善负性情绪可能提高RA患者的生活质量。     

State of knowledge of helminth fauna of freshwater fishes of Poland

A total 89 fish and lamprey species has been recorded from Polish freshwater habitats. Twenty-seven of them (30.3%) have not been surveyed for parasitic helminthes. Some of the latter fishes are either rare or not easily accessible. Other live only in specific habitats in scattered localities. An important obstacle for studying parasite faunas of some fishes may be their status on an endangered species. Among the non-surveyed fishes, are those which have been relatively recently introduced to Poland or migrated there on their own. The present paper attempts to review all hitherto not studied helminthologically fish species, their habitats, localities and current protection status.     

Inhibition of intimal thickening of the carotid artery of rabbits and of outgrowth of explants of aorta by probucol.

The effect of administration of probucol in preventing intimal thickening of rabbit carotid artery after balloon catheter injury and the mechanism of action of the drug were studied. Groups of 6 male New Zealand-White rabbits were given normal diet (Group I), high cholesterol diet (Group II) or high cholesterol diet plus probucol (Group III) for 4 weeks. Balloon catheter injury was made in week 2 and animals were killed in week 4. No significant differences in the total cholesterol levels in Groups II and III were found in week 4. The medians of areas of the intimal layer in cross-sections of the carotid arteries of Groups I, II and III were 0.237, 0.475 and 0.309 mm2, respectively. Thus high-cholesterol diet increased the thickness of the intimal layer and probucol reduced its effect. There were no significant differences in the areas of the medial layers in these 3 groups. For the examination of the mechanism of the effect of probucol, rabbits were given chow containing 0.5% cholesterol with and without 0.5% probucol (7 rabbits each) and then the numbers of explants from their aortas showing outgrowth were compared. The plasma total cholesterol levels of these two groups were the same. The probucol concentrations in the plasma and aorta of the former group were 18.6 +/- 13.2 micrograms/ml and 7.3 +/- 5.4 micrograms/g wet tissue, respectively. The number of explants showing outgrowth on day 14 was suppressed by 34% in the probucol-treated group.(ABSTRACT TRUNCATED AT 250 WORDS)