柴胡解毒汤联合干扰素治疗慢性乙肝的疗效和对细胞因子的影响及机制

目的:观察柴胡解毒汤在治慢性乙型肝炎方面的临床疗效,并借此探讨该方对细胞因子的影响。方法:选取2015年9月至2016年3月重庆三峡高等专科学校附属医院收治的慢性乙型肝炎患者90例,随机分成对照组和观察组,每组45例。对照组采用干扰素注射,1次/d,连续2周后,再改为隔日1次,连用3个月;观察组在使用干扰素基础上采用中药柴胡解毒汤治疗,2次/d,同样治疗14 d后观察2组治疗的临床疗效、肝功能比较、药物不良反应、血清IL-1β、IL-6、5-HT及TNF-α水平的变化、HBs Ag、HBe A、HBV-DNA阴转率等情况。结果:1)治疗后观察组有效率86.67%,对照组有效率68.89%,2组有效率比较,差异有统计学意义(P0.05);2)2组与治疗前比较,肝功能指标均有明显改善,差异有统计学意义(P0.05);治疗后,观察组ALT、AST及TBIL值均明显低于对照组,差异有统计学意义(P0.05);3)不良反应中,对照组出现10例(33.00%),观察组4例(8.80%),观察组不良反应明显低于对照组,差异有统计学意义(P0.05);4)2组患者在治疗前,检测的血清IL-1β、IL-6、5-HT及TNF-α含量比较,差异无统计学意义(P0.05),而组间治疗后比较,观察组明显低于对照组,治疗后,上述指标均较治疗前下降,但观察组下降更明显,差异有统计学意义(P0.05);5)观察组HBs Ag阴转率为24.4%、HBe Ag阴转率为33.3%、HBV-DNA阴转率为48.8%均明显高于对照组,对照组HBs Ag阴转率为15.5%、HBe Ag阴转率为11.1%、HBV-DNA阴转率为28.9%,2组比较差异有统计学意义(P0.05)。结论:柴胡解毒汤在治疗慢性乙肝方面有显著的临床效果,且不良反应较传统干扰素明显降低,值得推广,同时,该药对细胞因子等指标也有明显降低作用,考虑其可能是通过类似机制起作用。     

Risk factors for bleeding after dental extractions in patients over 60 years of age who are taking antiplatelet drugs

The aim of this retrospective, single-centre study was to identify the risk factors for bleeding after dental extractions in patients aged over 60 who were being treated with antiplatelet drugs. A total of 338 patients who fulfilled the inclusion criteria were enrolled, and their personal and clinical details, and complications with bleeding after extraction, were retrieved and recorded. There were 182 men and 156 women (mean (SD) age 72 (8) years). A total of 469 teeth were extracted, with a mean (SD) of 1.4 (0.6) teeth/patient. Seventy-seven patients (23%) developed mild, and 55 (16%) severe, bleeding postoperatively. No patient developed a major cardiovascular or cerebrovascular event. We calculated the significance of the association of different variables with the occurrence of postoperative haemorrhage using a multivariate stepwise logistic regression model. The presence of three or more coexisting conditions, a complicated tooth extraction, and the use of two antiplatelet drugs were independent risk factors, while discontinuation of antiplatelet treatment four or more days before the tooth was extracted was a protective factor. This suggests that clinicians should assess the thrombotic risk associated with the interruption of antiplatelet drugs as well as the risk of bleeding for each patient before dental extraction. Strong and effective measures for haemostasis may be preferred over blind discontinuation of antiplatelet drugs. This study is registered in the Chinese Clinical Trial Registry (No. ChiCTR1800014355).     

麻疹疫苗保护效果及其影响因素

高质量麻疹疫苗接种是消除麻疹的主要策略，我国自1978年将麻疹疫苗纳入计划免疫，尤其是1986年实施2剂次麻疹疫苗接种程序以来，麻疹发病率大幅下     

Alopecia areata. How not to miss Satoyoshi syndrome?

Satoyoshi syndrome is a multisystem disorder of suspected autoimmune etiology, characterized predominantly by alopecia, muscle spasms and diarrhea. Antinuclear antibodies are present in 60% of patients. The syndrome primarily affects girls and young women. Trichoscopy shows regularly distributed yellow dots, indistinguishable from typical alopecia areata. The condition may be easily misdiagnosed and treated as alopecia areata. On the basis of an in‐depth analysis of all published cases we developed diagnostic criteria for Satoyoshi syndrome. We also suggest that two subtypes of the disorder should be distinguished, the ANA‐positive Satoyoshi syndrome with generally good response to systemic glucocorticosteroid therapy and the ANA‐negative Satoyoshi with less favorable prognosis. In our opinion all patients will alopecia areata (in particular alopecia totalis) should be inquired about muscle spasms and diarrhea and tested for antinuclear antibodies to decrease the risk of missing Satoyoshi syndrome.