非酒精性脂肪性肝病发病机制及治疗进展

近年来,非酒精性脂肪性肝病(Nonalcoholic fatty liver disease,NAFLD)发病率在世界范围内逐渐上升,在我国是仅次于病毒性肝炎、酒精性脂肪性肝病的导致肝硬化的主要病因之一。其发病机制尚不清楚,目前较为公认的机制为"二次打击"学说,第一次打击为胰岛素抵抗,脂质代谢紊乱导致肝细胞内脂质过度沉积,三酰甘油增多;第二次打击是肝细胞内氧化应激及脂质过氧化,是发展为NASH、肝硬化甚至肝癌的关键。近年来,对胰岛素增敏剂治疗NAFLD的研究较多,而关于降脂药的研究则少见。本综述从NAFLD的概述、发病机理、降血脂药的作用等方面进行阐述。     

Pathogenesis and treatment of Wilson's disease

Authors review the pathogenesis, symptoms and diagnosis of Wilson's disease. Wilson's disease or hepatolenticular degeneration is an autosomal recessive disorder. It is caused by defective hepatic excretion of copper. The disease is fatal without treatment. The prevention of severe permanent damage depends upon early recognition and diagnosis followed by appropriate lifelong anticopper treatment. The purpose of the therapy of Wilson's disease is to eliminate the copper by chelators (D-penicillamine, triethylene tetramine, ammonium tetrathiomolibdate) and to inhibit the absorption and accumulation of copper by zinc salts (zinc sulphate, zinc acetate, zinc gluconate).     

尿毒症患者瘙痒的发病机制及治疗研究进展

瘙痒是一种皮肤局部不适感,可引起搔抓欲望.尿毒症皮肤瘙痒(UP)的相关研究已有百余年历史,但其发病机制至今尚未完全阐明,临床治疗依然面临挑战.本文综述尿毒症患者瘙痒的发病机制及治疗研究进展.     

老年痴呆症的发病机制及临床药物治疗

老年痴呆发病率随着我国老龄化问题的凸显日益加剧,其发病机制主要学说是淀粉样肽假说,治疗药物主要有胆碱能药物、改善脑循环或脑代谢药物、神经保护药物等。     

Pathogenesis and treatment of pruritus in cholestasis

Pruritus is an enigmatic, seriously disabling symptom accompanying cholestatic liver diseases and a broad range of other disorders. Most recently, novel itch-specific neuronal pathways, itch mediators and their relevant receptors have been identified. In addition, new antipruritic therapeutic strategies have been developed and/or are under evaluation. This review highlights recent experimental and clinical findings focusing on the pathogenesis and actual treatment of pruritus in cholestatic liver disease. Evidence-based therapeutic recommendations, including the use of anion exchange resins cholestyramine, colestipol and colesevelam, the microsomal enzyme inducer rifampicin, the opioid receptor antagonists naltrexone and naloxone, and the serotonin reuptake inhibitor sertraline, are provided.     

额颞叶退行性的发病机制与治疗

额颞叶退行性变包括3种临床综合征:行为变异额颞叶型痴呆即狭义的额颞叶痴呆或额颞叶痴呆额叶型、语义性痴呆和进行性非流利性失语。本文综述额颞叶退行性的病因、病理、诊断和治疗的最新进展。     

Pathogenesis and treatment of neuroleptic malignant syndrome

1. Neuroleptic drugs (antipsychotics) produce numerous side effects which include serious extrapyramidal symptoms consisting of akathisia, dystonia, neuroleptic malignant syndrome, parkinsonian reactions such as postural abnormality, tremor, akinesia or bradykinesia, rigidity, and tardive dyskinesia. 2. Among the complications of neuroleptic chemotherapy, the most serious and potentially fatal complication is malignant syndrome, which is characterized by extreme hyperthermia, "lead pipe" skeletal muscle rigidity causing dyspnea, dysphagia, and rhabdomyolysis, autonomic instability, fluctuating consciousness, leukocytosis, and elevated creatine phosphokinase. 3. Neuroleptic malignant syndrome should be differentiated from malignant hyperthermia, lethal catatonia, and other pathological states producing some of these same symptoms. 4. In addition to neuroleptics, malignant syndrome has been caused by thymoleptics (antidepressants), metoclopramide (antiemetic), metoclopramide combined with cimetidine, tetrabenazine, overdosage of benzodiazepine, phenelzine, dothiepin and alcohol, and amphetamine. 5. Factors leading to and/or facilitating the emergence of neuroleptic malignant syndromes are reportedly organic brain syndrome, dehydration, exhaustion, external heat load, excessive sympathetic discharge, use of long acting neuroleptics, high doses of neuroleptics, rapid dose titration with neuroleptics, abrupt discontinuation of antiparkinsonism agents, and concurrent lithium therapy. 6. Although, the pathogenesis of neuroleptic malignant syndrome is not understood completely, a blockade of dopaminergic receptors in the hypothalamus, spinal cord and striatum, an alteration of dopaminergic-serotonergic transmission in the body, an enhanced synthesis and action of prostaglandin E1 and E2, and a modification of calcium-mediated signal transduction in the body have been suggested. 7. The treatment of malignant syndrome includes immediate withdrawal of neuroleptic drugs, i.v. infusion of dantrolene, and oral administration of bromocriptine; or alternatively i.v. infusion of dantrolene and the combination of levodopa-carbidopa. 8. Other measures to enhance the therapeutic effectiveness of the aforementioned regimens are to include the use of anticholinergic drugs such as benztropine to enhance the effectiveness of bromocriptine, of lorazepam if catatonic symptoms persist, or of electroconvulsive therapy (ECT) if psychotic symptoms persist. 9. These treatments, however, must be "active" rather than "passive", in order to avert fatalities and/or unfortunate sequelae from this iatrogenic and incompletely understood disease.     

Pathogenesis and treatment of leukemia: an Asian perspective

INTRODUCTION: Leukemias occur worldwide, but there are important geographic differences in incidences. AREAS COVERED: Three leukemias with special Asian perspectives, acute promyelocytic leukemia (APL), T-cell large granular lymphocyte (T-LGL) leukemia and NK-cell leukemia. EXPERT OPINION: In APL, China has made contributions in discovering the efficacy of all-trans retinoic acid (ATRA) and arsenic trioxide. Some APL patients are potentially curable after treatment with ATRA or arsenic trioxide as a single agent. Combined treatment of APL with ATRA and arsenic trioxide induces remission with deeper molecular response. An oral formulation of arsenic trioxide is available, making outpatient treatment feasible. Future regimens for APL should examine how ATRA and arsenic trioxide can be optimally combined with other synergistic drugs. Asian patients with T-LGL leukemia present more frequently with pure red cell aplasia, but less frequently with neutropenia, recurrent infection, splenomegaly and rheumatoid arthritis as compared with Western patients. These differences have potential effects on treatment and disease pathogenesis. NK-cell leukemia is rapidly fatal and occurs almost exclusively in Asian and South American patients. Conventional anthracycline-based chemotherapy designed for B-cell lymphomas do not work in NK-cell leukemias. Novel therapeutic approaches targeting cellular signaling pathways or preferentially upregulated genes are needed to improve outcome.     

慢性肾病合并矿物质与骨代谢紊乱的发病机制、临床诊断与治疗

慢性肾病（CKD）患者的血液钙、磷、甲状旁腺激素、维生素D、成纤维细胞生长因子-23、等生化因子的水平会发生异常,这不仅能导致长期的系统性并发症,还会引起骨矿物质代谢失衡,造成骨损伤,增加慢性肾病合并矿物质与骨代谢紊乱（CKD-MBD）的患病率和死亡率。本文对CKD-MBD的发病机制、临床诊断与治疗策略作一综述。     

肠易激综合征发病机制与诊治

<正> 肠易激综合征(irritable bowel syndrome,IBS)是与肠道动力学异常及内脏感觉异常有关的功能性胃肠疾病,是指一组包括排便习惯改变(腹泻或便秘)、粪便性状异常(稀便、黏液便或硬结便)、腹痛及腹胀等临床表现的症候群,持续存在或间歇发作,并无器质性疾病(形态学、细菌学及生化代谢等异常)的证据。目前IBS仍被认为是功能性疾病,许多研究已显示IBS患者具有胃肠动力学异常和内脏感觉异常的病理现象。尽管IBS不危及人的生命,却对工作、生活产生不同程度的影响,使人     

急性重症胰腺炎的发病机制及治疗进展

急性重症胰腺炎是外科常见的急腹症,是急性胰腺炎中病情危重且死亡率较高的一种类型。近年来的研究发现肥大细胞（Mast cell MC）等炎症细胞所释放的炎症介质、肠屏障的破坏以及微循环障碍在SAP进程中起着重要作用,治疗策略由外科手术甚至扩大手术范围为主发展到当今手术、非手术并重,注重个体化综合治疗的过程。本文综合了其中的一些观点及结论加以综述.     

多发性骨髓瘤骨病发病机制的研究及治疗进展

多发性骨髓瘤(Multiple myeloma,MM)是恶性克隆性浆细胞疾病,骨髓瘤骨病(Myeloma bone disease,MBD)是其重要的临床表现之一.其发病机理与骨吸收增加及骨生成减少有关,对骨髓瘤骨病病理机制的研究促进了新的靶向性药物研发.现就目前已知参与MBD发病机制及治疗新进展作一综述.     

维持性血液透析患者神经系统并发症的发病机制及其治疗

神经系统损害是维持性血液透析(MHD)患者常见并发症,常规血液透析对神经系统病变的改善作用甚微,肾移植是目前惟一可治愈尿毒症患者神经病变的方法.本文综述MHD患者认知功能损害、尿毒症神经病变、自主神经病变、腕管综合征、不宁腿综合征等神经病变的发病机制及其治疗.     

维持性血液透析患者继发性甲状旁腺功能亢进及其治疗

继发性甲状旁腺功能亢进(SHPT)是慢性肾脏病(CKD)的常见并发症,恰当的治疗可有效控制高磷血症、维持血钙和甲状旁腺素水平的正常,降低CKD患者死亡率.新型磷结合剂、维生素D类似物及钙敏感受体激活剂等现已陆续进入临床,并取得良好疗效.本文探讨SHPT发病机制及其治疗的最新研究进展.     

肠易激综合征腹痛的发生机制和治疗

目的探讨肠易激综合征腹痛的发生机制及治疗方法。方法选取2011年5月～2012年5月在本院治疗的103例肠易激综合征腹痛患者为研究对象,全部患者给予综合对症治疗,观察其腹痛时间、腹痛次数、腹痛频率和腹痛程度改变情况。结果治疗后,肠易激综合征腹痛患者的腹痛时间明显缩短,腹痛次数减少,腹痛频率降低,腹痛程度明显减轻。结论造成肠易激综合征腹痛的原因有多种,临床对神经系统和胃肠系统作全方位的检查,根据病因对症治疗,可有效缓解其临床症状。     

Pathogenesis and treatment of human genital papillomavirus infections: a review

HPV infection of the genital tract is common and anogenital warts or condyloma acuminatum is increasing rapidly in incidence. In addition, certain HPV types are closely associated with genital tract malignancies. Although recent advances in molecular biology have led to an increased understanding of the organization and functions of the papillomavirus genome, the pathogenesis of HPV infections and host responses to these diseases remain poorly understood. Treatment of anogenital warts is difficult and no completely satisfactory treatment modality is currently available. Comparatively few therapeutic modalities have been thoroughly evaluated, although recent studies of intralesionally and parenterally administered interferons have demonstrated beneficial effects of interferon compared to placebo. Additional studies of treatment for condyloma acuminatum are needed and should include the use of biologic response modifiers such as interferons, as well as antiviral drugs, with or without conventional methods of local therapy.