补肾中药靶向经穴给药对骨质疏松患者的归经调节

目的:通过临床实验观察补肾方药靶向经穴位给药治疗骨质疏松症的疗效,分析靶向给药与药物归经的相关性。方法:①观察对象:选择2004-08/2006-12河北医科大学骨质疏松专科门诊和石家庄市桥东区医院门诊骨质疏松患者180例(患者知情同意,并经单位伦理委员会批准)。②实验分组:采用随机数字表法将180例患者分为6组:补肾方药口服组,外贴肾经组,外贴膀胱经组,依普拉封组,骨疏康组,非经非穴位组,每组30例,平均年龄(60.5±6.0)岁,平均病程(6.32±2.03)年。6组一般资料差异无显著性(P>0.05),具有可比性。补肾方药由地黄、淫羊藿、山药、丹参、骨碎补、独活等药物组成,每5丸含原药材3g;抗骨松贴剂:由地黄、淫羊藿、山药、丹参、骨碎补、独活等药物组成);依普拉封为正大青春宝药业有限公司产品;骨疏康颗粒由熟地黄、淫羊藿、黄芪、丹参、骨碎补、木耳、黄瓜子组成。③实验干预:补肾方药口服组:口服补肾方药10丸/次,3次/d,连续服用6个月。外贴肾经穴位组:选择足少阴肾经原穴太溪和络穴大钟;外贴膀胱经穴位组:选择足太阳膀胱经背部肾俞穴和络穴飞扬;外贴非经非穴位组:选择大腿外侧和后背部较广阔没有经络循行的区域;外贴组每个穴位贴2g生药量,每2天1次,左右交替进行。依普拉封组:口服依普拉封200mg/次,3次/d。骨疏康组:口服骨疏康颗粒10g/次,2次/d,各组均以6个月为1疗程,用药期间不进行任何其他中西医抗骨质疏松治疗。④实验评估:比较6组的骨痛症状与骨密度、血清Ca、P、碱性磷酸酶、尿羟脯氨酸,甲状旁腺素、降钙素、雌二醇、睾酮等指标的变化情况。进行综合疗效评价,评估标准分为显效、有效、无效。结果:180例患者全部进入结果分析。①补肾方药口服组、外贴肾经组、外贴膀胱经组、依普拉封组、骨疏康组治疗后,升高骨密度、雌二醇、睾酮、降钙素;降低甲状旁腺素;总有效率分别为90.0%,83.33%,83.33%,83.33%,83.33%。②非经非穴位组治疗后,骨密度、雌二醇、睾酮、降钙素、甲状旁腺素与治疗前比较差异无显著性(P>0.05);总有效率为46.67%。结论:靶向经穴给药可明显提高补肾方药的归经调节作用,至少在骨和性腺两个靶点起作用。     

Long‐term follow‐up after nonurgent percutaneous coronary intervention in unprotected left main coronary arteries

Objectives : To evaluate the long‐term outcomes of the selected patients by the local Heart Team to undergo percutaneous coronary intervention (PCI) of unprotected left main coronary artery (ULMCA) stenosis and to compare patients considered at low surgical risk versus at high surgical risk for coronary artery bypass grafting (CABG). Background : CABG is recommended in patients with ULMCA stenosis according to the AHA/ACC and ESC guidelines, and there are limited data on the long‐term outcomes in patients selected by the local Heart Team to undergo PCI. Methods : Between 1996 and 2007, 227 patients underwent PCI for ULMCA stenosis based on decision of the local Heart Team and patient's and/or physician's preference. All patients were contacted at 1 year and in November 2008. Results : Long‐term follow‐up was up to 8 years with a mean of 3.9 ± 2.6 years. Overall, the Kaplan–Meier estimate of the composite of cardiac death, myocardial infarction (MI), or target lesion revascularization (TLR) was 14.8% at 1 year, 18.3% at 3 years, and 20.9% at 5 years with no events occurring thereafter. Patients considered at low surgical risk for CABG had a significantly lower incidence of cardiac death or MI compared to patients considered at high surgical risk at 8 years (1.4 vs. 16.8%; 1.4 vs. 14.8%, respectively); however, no significant difference was observed for cardiac death, MI, or TLR (18.6 vs. 24.4%). Conclusions : PCI of ULMCA stenosis in patients selected by the Heart Team resulted in good long‐term clinical outcomes with most events occurring within the 1st year. Patients considered at low surgical risk for CABG have a significantly better long‐term survival than patients at high risk for surgery. © 2010 Wiley‐Liss, Inc.     

哮喘动物模型免疫炎症反应发生验证的要点

目的:了解哮喘免疫炎症反应发生和验证要点,为确保实验的成功打下基础。方法:就哮喘模型制备的动物选择,模型制备的时间,模型制备的方法以及如何评定动物哮喘模型成功作经验性的总结及对国内外对哮喘模型比较经典的认同的方法加以阐述。结果:①选用豚鼠制备哮喘模型,可以很好的观察哮喘发作症状,接受致敏物质后反应程度与其他动物相比较强,能产生I型变态反应。②哮喘模型的制备时间应避开冬天,春夏时节最为合适,制备的哮喘模型炎症反应明显。③1%卵蛋白雾化吸入激发哮喘比较科学。④通过哮喘症状,动物肺功能仪测定肺功能,苏木精伊红病理染色,酶联免疫吸附测定血清IgE水平4种方法做哮喘免疫炎症反应的定性分析。结论:根据不同的研究目的选用相应的动物、恰当的致敏时间,制定稳妥的方法和良好检验手段是确保实验成功的关键。