肝素诱导的重度血小板减少症并咯血1例

目的肝素诱导的血小板减少症(HIT)是应用肝素后出现的一种罕见的、较为严重的药物不良反应。使用肝素后患者出现HIT的发病率约为0.2%,一般在肝素使用后5~14天开始,血栓栓塞形成等并发症风险明显增加。方法本文分析1例下肢动脉闭塞患者在使用低分子肝素治疗过程中多次出现血小板减少的临床资料,并结合相关文献进行复习,结果分析HIT的发病机制、临床特征、诊断依据及防治措施。结论通过整个诊疗过程,明确抗凝方案选择。     

左旋叶下珠复合物治疗52例早期乙型肝炎病毒相关肿瘤的临床疗效

Objective:To observe the change in the number of antibodies of preneoplastic hepatocellular carcinoma(HCC) using early treatment by Compound Phyllanthus Urinaria L.(CPUL) on patients with preneoplastic hepatitis B virus(HBV)-associated HCC.Methods:A total of 102 cirrhosis patients with regenerative or dysplastic nodules whose sera were tested positive for at least one of these six proteins(five up-regulated genes URG4,URG7,URG11,URG12 and URG19,and one down-regulated gene DRG2) were assigned randomly to two groups using continual random codes by SPSS software.Fifty-two patients were in the treatment group and 50 patients were in the control group.CPUL was used in the treatment group for 3 years,while the control group did not receive any treatment.The changes in HBV-DNA level,number of antibodies,and hepatocarcinogenesis occurred were observed.Patients who did not develop HCC were followed up for another 2 years.Results:HBV-DNA levels decreased 2log in 22.2%(10/45) of patients in the treatment group in contrast to only 5.0%(2/40) of patients in the control group(P=0.0228).The number of antibodies that were tested positive in the treatment group(1.08± 1.01)was significantly lower compared with the control group(2.11 ±1.12) after 24 months of drug treatment(P0.01).Both the positive rates of anti-URG11(33/52) and anti-URG19(31/52) were over 60%at baseline in the two groups,and were decreased to 48.1%(25/52) and 46.2%(24/52) respectively at 36 months of drug treatment,while the rates increased to 68.0%(34/50) and 66.0%(33/50) respectively(P=0.0417,P=0.0436) in the control group.The positive rate of anti-DRG2 was increased to 55.8%(29/52) at 36 months of drug treatment,while in the control group was decreased to 36.0%(18/50,P=0.0452).Among the 102 patients who developed HCC,2 were in the treatment group and 9 were in the control group,meaning that a significant difference between the two groups(P=0.0212).In11 patients who developed HCC,anti-URG11 and anti-URG19 were always positive,while anti-DRG2 was negative.Patients newly developing HCC were 6(20.0%) in the control group,and only one(2.5%) in the treatment group(P=0.0441) during 2-year follow-up after the end of the treatment.Conclusions:Anti-URG11,anti-URG19 and antiDRG2 could be used as early markers in the prediction of the therapeutic efficacy of CPUL in treating preneoplastic HCC.CPUL is useful in preventing or delaying the development of HBV-associated cirrhosis to HCC.     

温补培元方对脾肾阳虚型小鼠红细胞免疫功能的影响

１ 材料动物：实验动物用近交系Ｃ５７ＢＬ 小鼠，６～８ｗ龄体重２２± ４ｇ左右，雌雄兼用，由中国科学院上海实验动物中心提供。实验前在本校实验中心饲养１ｗ，全部实验期间，加喂生葵花子和鸡蛋黄。药物：人参（红参）、黄芪、附子、山萸肉、黄柏等由安徽中医学院附院中医房提供。试剂：补体致敏酵母菌和非致敏酵母菌，由上海长海医院免疫室提供。２方法２．１ 动物分组与造模方法 将４０只小鼠随机分为４组．每组１０只，空白对照组：每天喂正常饲料，每次３ｇ，每ｄ２次，同时给生理盐水胃饲０．３ｍｌ／次／ｄ，连续１４ｄ；病理模…     

熊去氧胆酸联合通胆汤对原发性胆汁性肝硬化的治疗作用

目的:观察熊去氧胆酸(ursodeoxycholic acid,UDCA)联合通胆汤治疗Ⅱ、Ⅲ期原发性胆汁性肝硬化患者30例的临床疗效.方法:60例入组的患者被随机分配到对照组(n=30)和治疗组(n=30),分别给UDCA和UDCA联合中药通胆汤治疗.在治疗4-24 wk分别记录患者的临床症状、肝功能、免疫指标及不良反应,并随访1-3年.结果:24 wk后,治疗组25例(83.3%)完全反应,对照组17例(56.7%)(P<0.05);治疗组第4周临床症状阳性率低于对照组(P<0.05),12wk后90%的患者症状基本消失;在降低胆汁淤积及转氨酶上治疗组均明显优于单用UDCA(P<0.05);治疗组IgM、IgG及IgA在治疗96 wk后较治疗前明显降低,与对照组比较有明显差异(1.93±1.71 g/L vs 2.16±1.81 g/L,10.25±6.23 g/L vs 12.45±5.98 g/L,1.86±1.72g/L vs 2.78±2.12 g/L,P<0.05).不良反应主要是腹泻与总胆汁酸升高所导致偶发皮肤瘙瘁,减量后很快缓解.结论:UDCA联合通胆汤治疗原发性胆汁性肝硬化,较单用UDCA能更有效改善临床症状与生化指标.     

试述新安“温补培元方”

中图法分类号Ｒ２８９．１温补培元方是在研究新安温补培元医家医案中总结出来的代表方剂,该方由人参、黄芪、附子、黄柏、山茱萸等１３味中药组成。现就其设计原理、方法等试述如下。１温补培元治法的提出新安自明·汪机始,出现了一批善用“温补培元”方药的医家群体,...     

补肾清透方对慢性乙肝HBeAg阳性患者血清IL-2、IL-4、IL-10、TNF-α及IFN-γ的影响

目的：观察补肾清透方治疗慢性乙型肝炎（CHB）乙型肝炎e抗原（HBeAg）阳性患者外周血中白细胞介素-2（IL-2）、白细胞介素-4（IL-4）、白细胞介素-10（IL-10）、肿瘤坏死因子α（TNF-α）和干扰素-γ（IFN-γ）的变化。方法60例CHB HBeAg阳性患者被随机分成治疗组和对照组,每组30例,C HB治疗组接受补肾清透方治疗,疗程48周,C HB对照组不接受药物治疗。分别在开始和第48周时两组患者抽血检测 HBV DNA、IL-2、IL-4、IL-10、TNF-α和IFN-γ。结果 CHB治疗组治疗后与治疗前比较,IL-2、TNF-α、IFN-γ明显升高,HBV DNA、IL-4、IL-10明显下降（P＜0．01）;CHB对照组治疗前、后各项指标比较,差异无统计学意义（P＞0．05）。结论补肾清透方能抑制CHB HBeAg阳性患者HBV DNA复制,可提高机体的细胞免疫功能。     

乙型肝炎相关肝癌的癌前病变早期干预的临床研究

肝癌前变是指一种很易发生癌变的组织病理学异常[1].近5年来,我们对影像学诊断为再生或不良结节的乙型肝炎肝硬化患者进行复方叶下珠干预和临床观察,试图为肝癌前病变提供一种简易的诊断方法与疗效判断指标.     

软肝冲剂抑制血管紧张素Ⅱ诱导的肝星状细胞上调基因的表达

目的:旨在研究软肝冲剂是否通过抑制血管紧张素Ⅱ(AngiotensinⅡ,AngⅡ)诱导的肝星状细胞(HSCs)上调基因起作用。方法:用DNA微点阵分析用AngⅡ(10-8M)以及AngⅡ和软肝冲剂(2.5mg/L)处理的HSCs与对照组之间基因的差异性表达,其结果用实时定量RT-PCR证实。用Westernblot分析软肝冲剂对HSCs在AngⅡ诱导下的胶原蛋白的表达,ELISA分析有生物活性的TGF-β1的含量。结果:软肝冲剂能抑制AngⅡ诱导HSCs上调基因的表达,特别是一些细胞外基质和细胞因子如IL-13,IL-15,MCP-2,TGF-1,TGF-2,细胞因子受体基因,如TGF-1受体。分泌到细胞培养基中的胶原蛋白和有生物活性的TGF-β1也被抑制。结论:软肝冲剂抑制AngⅡ诱导HSCs上调的基因的表达,这可能是软肝冲剂治疗肝纤维化和肝硬化的机制之一。     

肝癖(非酒精性脂肪性肝炎)诊疗方案

随着生活水平的提高,中国脂肪性肝病(简称脂肪肝)的发病率逐年提高,已成为我国第一大肝病。脂肪肝的危害正在逐步被医学界重视,但目前尚缺乏有效的药物治疗,中医药在脂肪肝方面的优势已得到广大医生和患者的认可。为进一步提高脂肪肝的中医药疗效,深圳市中医院肝病科依托国家中医药管理局华南区中医肝病诊疗中心联盟理事长单位,牵头联合广东省、广西壮族自治区和海南省肝病专家,以国家中医药管理局发布的《肝癖(脂肪性肝病)诊疗方案》为蓝本,结合脂肪肝的研究进展,更新、修订形成了《肝癖(非酒精性脂肪性肝炎)诊疗方案》,为华南区肝癖的中医预防、辨证治疗提供依据。