撰文写稿 贵在创新——兼评《怪病从“痰”辨治的体会》

近读贾河先同志的“怪病从‘痰’辨治的体会”一文(刊在《吉林中医药》1984年5期),觉得贾文内容似与《论中医痰病学说》(朱曾柏著,湖北人民出版社1981年6月出版)相同处甚多。现列举如下: 其一:贾文对痰病痰症有二点认识,即     

早期非创伤性股骨头坏死患者脂联素及相关因子与骨髓水肿及疼痛分级的相关性研究

目的:探讨早期股骨头缺血性坏死患者( INFH)脂联素、CRP、TNF-α和NO等相关因子水平与骨髓水肿及疼痛分级的相关性.方法:回顾性分析我院门诊及住院部2010年5月～10月收治的120例INFH患者(138个髋关节).根据MRI将骨髓水肿分为0～2级,根据主诉疼痛分级法将疼痛分为0～2级,脂联素、TNF-α及NO水平采用ELISA方法检测,CRP及血脂水平送我院生化室常规检测.统计学分析脂联素因子水平与骨髓水肿及疼痛分级的相关性.结果:104髋发生骨髓水肿,发生率为75.4％,相关性分析显示疼痛分级与骨髓水肿存在正相关(P＜0.01).在骨髓水肿患者中测定血清脂联素、CRP、TNF-α及NO含量,各级患者间比较有统计学差异(P均＜0.05),在不同程度疼痛患者中,血清脂联素、CRP、TNF-α及NO含量在各级间比较有统计学差异(P均＜0.05).相关分析显示脂联素与骨髓水肿及疼痛分级存在明显负相关(P＜0.01),CRP、TNF-α、NO等与疼痛存在正相关(P＜ 0.01).结论:早期INFH患者体内脂联素水平与骨髓水肿、疼痛分级关系密切,可作为病情进展评价及疗效判定的指标,为临床诊疗该疾病提供新的思路.     

CD44对体外培养的成骨细胞及破骨样细胞形成过程中的影响

目的 通过体外细胞培养探讨粘附分子CD44在成骨细胞及破骨样细胞形成过程中的作用.方法 在体外培养的骨髓间充质干细胞向成骨细胞分化过程中,用免疫细胞化学方法来检测其细胞CIM4的表达及其意义;并在细胞核因子kB受体活化因子配基(receptor activator of nuclear factor-k B ligand,RANKL)和巨噬细胞集落刺激因子(Macrophage-colony stimulating factor,M-CSF)诱导的破骨样细胞培养体系中加入CD44抗体,通过抗酒石酸酸性磷酸酶(TRAP)染色鉴定破骨样细胞的形成.结果 成骨细胞培养体系中,空白组及地塞米松干预组间细胞CD44的表达没有显著性差异,但是指数增长期,地塞米松干预组的CD44的表达上升慢;破骨样细胞培养体系中,第6和9天,CD44抗体干预组的TRAP阳性细胞率明显低于对照组.结论 CD44在成骨细胞形成、增殖、成熟过程没有促进作用,但在破骨样细胞形成过程中起着一定的促进作用,它与单个核细胞的融合有一定的关系.     

Effects of salivae miltiorrhizae liguspyragine hydrochloride and glucose injection (参芎葡萄糖注射液) on the levels of main platelet thrombin receptors in chronic haemodialysis patients

Objective:To investigate the effects of Salvia Miltiorrhiza Liguspyragine Hydrochloride and Glucose Injection(参芎葡萄糖注射液,SLGI) on the expression of platelet membrane receptors proteinase-activated receptor-1(PAR1) and proteinase-activated receptor-4(PAR4) in end-stage renal disease(ESRD) patients on chronic haemodialysis(HD).Methods:Eighty-six ESRD patients on HD(treated group) were treated with SLGI,7 days as one therapeutic course,for two successive courses.The previous therapies were unchanged.Flow cytometry was used to assess the expression of platelet PAR1 and PAR4 in the patients,and turbidity method was used to determine the platelet maximum aggregation rate(MAR).Meanwhile,renal function was measured.The final data were compared with those before treatment and with those in the normal control group(54 healthy subjects).Results:Compared with the normal control group,the expressions of PAR1 and PAR4 and platelet MAR in ESRD patients on HD was significantly higher before treatment(P=0.001,P=0.006, and P=0.008);after treatment with SLGI,the above indices in patients were remarkably decreased(P=0.036 and P=0.046),except PAR4(P=0.067),but still higher than those in the normal control group,however,it was not statistically significant.Conclusions:(1) The overexpression of PAR1 and PAR4 might lead to increased platelet aggregation and this could be one of the reasons for the thrombotic events in ESRD patients on HD.(2) SLGI was able to down-regulate the expression of PAR1 in ESRD patients on HD,improve platelet function,and regulate platelet activation.     

规范化术后疼痛护理常规在术后镇痛中的作用

目的研究规范化术后疼痛护理常规能否起到加强疼痛管理、改善急性术后疼痛的作用.方法 80例拟行择期腹部手术的患者随机分为实验组和对照组(每组n=40).实验组制定并执行规范的术后疼痛护理常规,对照组仍按照护理人员现有的护理习惯进行疼痛护理,不作干预.观察2组患者的术后疼痛水平、焦虑水平、镇痛药物使用及其副作用和患者对镇痛泵满意度及总体满意度.结果 实验组术后3天的每日疼痛评分和每日疼痛评分>4分持续时间均低于对照组(P<0.05),实验组术前1天晚上和术后3天状态焦虑评分低于对照组(P<0.05),2组间镇痛药物使用量相当(P>0.05),而实验组恶心、呕吐和嗜睡的发生率较对照组低(P<0.05).实验组患者对镇痛泵的满意度和总体满意度评分均高于对照组(P<0.05).结论 护理人员通过执行规范化的术后疼痛护理常规,可以达到加强疼痛管理、改善急性术后疼痛的目的.     

中药促进骨折愈合疗效机理研究新进展

骨折愈合是一个极其复杂的生物学修复过程 ,受诸多因素的影响。如何早期促进骨折愈合一直是骨伤科领域研究的重点课题。自从 1 962年刘润田[1] 首次报道中药促进骨折愈合的动物实验研究以来 ,人们根据中医理体系和现代科技成果 ,采用各种不同实验手段和方法 ,从不同角度进行了深入的研究 ,并取得较为理想的结果 ,显示出中医药促进骨折愈合的优势。既往研究的主要成果有中药改善骨折部位的血液供应 ,促进局部血肿的吸收与机化 [2 ] ;促进骨折部位骨基质钙盐沉积 [3,4 ] ;提高骨痂的质量及生物力学性能 [5～ 10 ] ;提高微量元素含量 [11,12 ]…     

伤科熏洗方对类风湿性关节炎患者血清肿瘤坏死因子-α和白细胞介素-1β水平的影响

目的探讨伤科熏洗方对类风湿性关节炎(RA)的疗效及其对RA患者血清肿瘤坏死因子-α(TNF-α)和白细胞介素-1β(IL-1β)水平的调节作用。方法选取110例RA活动期患者,随机分为治疗组和对照组,每组55例。治疗组采用伤科熏洗方联合西药治疗,对照组仅用西药治疗,共4周。观察2组的临床疗效以及治疗前后临床症状和实验室指标的变化,采用ELISA法检测患者血清TNF-α和IL-1β水平。结果治疗组和对照组总有效率分别为72.7%和49.1%,治疗组明显高于对照组(P0.05)。治疗组和对照组临床症状均明显改善(P0.05),但治疗组明显优于对照组(P0.05)。治疗组血沉、C反应蛋白、TNF-α和IL-1β水平均明显降低(P0.05),对照组无明显变化(P0.05)。结论伤科熏洗方下调TNF-α和IL-1β可能是其治疗RA的重要机制之一。     

穴位埋线对实验性结肠炎大鼠的脾淋巴细胞核因子-κB p65及相关信号分子β2AR的影响

目的:探讨穴位埋线治疗溃疡性结肠炎的作用机制.方法:将18只SD大鼠随机分为3组:正常对照组、模型组、穴位埋线组,每组6只.除正常对照组未行造模外,其余2组大鼠均采用三硝基苯磺酸(TNBS)造摸.模型组不予干预,正常饮食,穴位埋线组于"上巨虚""天枢""大肠俞"处进行穴位埋线治疗.治疗15 d后观察大鼠的腹泻、便血症状和结肠病理组织学改变,用western blot法检测大鼠脾淋巴细胞核因子-κB p65(NF-κB p65)及相关信号分子β2肾上腺素受体(β2AR)蛋白的表达.结果:穴位埋线组的大鼠腹泻、黏液脓血便症状得到较快控制,大鼠黏膜组织损伤明显改善;与正常对照组相比,模型组大鼠脾淋巴细胞NF-κB p65增多(P<0.01),β2AR的表达减少(P<0.01),两组差异有统计学意义;与模型组比较,穴位埋线组大鼠脾淋巴细胞NF-κB p65减少(P<0.01),而β2AR的表达增多(P<0.01),两组脾淋巴细胞NF-κB p65和β2AR的表达存在明显差异.结论:穴位埋线治疗实验性结肠炎有明显效果,其作用机制可能是通过调节NF-κB p65及相关信号分子β2AR,从而发挥治疗作用.

Abstract：

T Objective To investigate the mechanisms of catgut implantation at acupoints onulcerative colitis. Methods Eighteen SD rats were randomly divided into a normal control group (NC),a model group (MO) and a catgut implantation group (CI) with 6 rats in each group. Animals in groupMO and group CI were treated by trinitro-benzene-sulfonic acid (TNBS) to establish model with colitis.symptoms of diarrhea and bloody stool, and changes in histopathology were detected 15 days afterthe treatment. Expressions of splenic lymphocyte nuclear factor κB p65 (NF-κB p65) and correlatedsignaling molecules (β2AR) were detected by the western blot method. Results Diarrhea and mucusbloody purulent stool were soon controlled, and mucous injures were obviously improved in group CI.The NF-κB p65 value of splenic lymphocytes was significantly increased (P<0.01) and expression ofβ2AR remarkably reduced in group MO (P<0.01), compared with group NC. But, the NF-κB p65 valuewas significantly decreased (P<0.01) and expression of β2AR remarkably increased in group CI (P<0.01), compared with group MO. Conclusion Catgut implantation at acupoints is obviously effectivein treating experimental colitis. Modulation of NF-κB p65 and the correlated signaling molecules β2ARmay be involved in the mechanisms.