肠炎清对溃疡性结肠炎大鼠TGF-β1/Smad3/ERK通路的影响

目的:观察肠炎清对溃疡性结肠炎(UC)大鼠的保护作用及对TGF-β1/Smad3/ERK信号通路的调控作用。方法:将25只雌性SD大鼠随机分为5组:空白对照组、模型组、美沙拉嗪组、肠炎清低剂量组和肠炎清高剂量组,除空白对照组外,其余大鼠均采用2,4,6三硝基苯磺酸(TNBS)诱导,建立UC模型。造模24 h后,模型组、空白对照组分别用0.9%生理盐水灌胃;美沙拉嗪对照组以30 mg／kg艾迪莎混悬液灌胃;肠炎清高剂量组以147.2 g／kg肠炎清灌胃;肠炎清低剂量组以36.8 g／kg肠炎清灌胃;1次/d,时间固定,持续7 d。检测结肠黏膜组织中转化生长因子（TGF）-β1、Smad3、胞外信号调节激酶（ERK)磷酸化的水平及TGF-β1信号通路活化的程度。结果:模型组ERK表达水平最低,低于溶媒对照组、美沙拉嗪组、肠炎清高剂量组和低剂量组,肠炎清剂量组该指标水平随剂量升高而上升,且高剂量肠炎清组ERK表达水平显著高于模型组。模型组TGF-β1和Smad3高于美沙拉嗪组组、空白对照组和肠炎清低剂量组及高剂量组。结论:肠炎清对UC大鼠肠黏膜具有保护作用,其机制可能与通过下调TGF-β1-Smad3通路,提高ERK表达有关。     

中西医结合治疗溃疡性结肠炎患者疗效及对血小板、凝血功能及炎性因子的影响

目的 探讨中西医结合治疗溃疡性结肠炎(UC)患者疗效及对血小板、凝血功能及炎性因子的影响.方法 以2019年6月-2020年6月我院收治的100例UC患者为对象,按照随机数字表法分为对照组与观察组.对照组采用美沙拉嗪治疗,观察组加用中药灌肠.比较两组疗效及凝血指标、炎症因子水平.结果 观察组总有效率为96.00％(48...     

胃食管反流病的中西医结合诊疗体会

刘万里教授主张诊疗胃食管反流病应重视中西医结合思维。在明确诊断的基础上，对胃食管反流病治疗采取分期疗法，发作期以快速愈合炎症、缓解控制症状为治疗目标，此阶段以西药为主、中药为辅；缓解期主要是巩固疗效、减少复发，中药为主、西药为辅。针对难治性胃食管反流病，刘万里教授强调优化诊疗方案的重要性，找到中医干预胃食管反流病的切入点，发挥中医药“治病求本”“辨证论治”等特色优势，可提高胃食管反流病的临床疗效，显著减少复发率。     

揿针治疗老年膝关节骨性关节炎疗效观察：随机对照试验

ObjectiveTo observe the effects of the thumb-tack needling therapy on knee joint pain and joint function in the elderly patients with knee osteoarthritis (KOA) and compared with medication.MethodsA total of 60 patients were randomized into a thumb-tack needling group and a medication group, 30 cases in each one. In the thumb-tack needling group, the therapy with the thumb-tack needle retaining and waiting for qi was adopted. The acupoints were Hèdĭng (EX-LE2鹤顶), Nèixīyăn (内膝眼EX-LE4), Dúbí (犊鼻ST35), Xuèhăi (血海SP10), Liángqiū (梁丘ST34) and Ashi points on the affected side. The needles were retained for 24 h. This therapy was given once every two days, 3 times a week. The treatment for 2 weeks was as one course and consecutive 2 courses of treatment were required. In the medication group, diclofenac sodium sustained release tablets were taken orally, 75 mg each time, once daily, consecutively for 4 weeks. Successively, the score of visual analogue scale (VAS) at the affected knee before treatment, after treatment and 3 months after treatment as well as Lequesne indicator before and after treatment were evaluated. The clinical therapeutic effect was observed in the patients of the two groups after treatment.Results(1) After treatment, VAS scores were reduced as compared with those before treatment in the patients of the two groups (both P < 0.05). After treatment, VAS score in the thumb-tack needling group was lower than that in the medication group (P < 0.05). (2) After treatment, the scores of all the items of Lequesne indices reduced as compared with those before treatment in the patients of the both groups, indicating significance differences (all P < 0.05). After treatment, compared with the medication group, the score of pain, morning stiffness and walking ability as well as the total score were all lower in the thumb-tack needling group, indicating significant differences (all P < 0.05). (3) The curative and remarkably effective rate and the total effective rate were 66.7% and 93.3% in the thumb-tack needling group, higher than 56.7% and 86.7% in the medication group respectively (both P < 0.05).ConclusionThe thumb-tack needling therapy effectively relieves knee joint pain and improves joint function in the patients and the therapeutic effect is better than medication group. Hence, this therapy deserves to be promoted in clinical practice.     

Splenectomy enhances the Ly6Clow phenotype in hepatic macrophages by activating the ERK1/2 pathway during liver fibrosis

Background and aim: Splenectomy has been reported to attenuate liver fibrosis. In addition, phenotype transitions of infiltrating macrophages, including Ly6C^high and Ly6C^low, play an essential role in the liver fibrosis. However, whether the spleen can regulate the phenotype switch of macrophages and the underlying mechanism still remain unclear. Methods: Chronic liver fibrosis in mice was induced by intraperitoneal injection with carbon tetrachloride. Splenectomy or sham operation was performed with or without depletion of macrophages during liver fibrosis. Liver fibrosis and the proportion of Ly6C^high and Ly6C^low macrophages were analyzed. Western blotting of ERK1/2 signals was performed in isolated macrophages to investigate the underlying mechanism of phenotype transition. RAW264.7 cells were stimulated by liver total cells conditioned medium with or without preincubation of SCH772984, the ERK1/2 inhibitor, and the phenotype switch of RAW264.7 cells was examined. In vivo, intraperitoneal injection of SCH772984 was performed on the splenectomy mice and the phenotype switch of liver infiltrating macrophages was tested. Results: Splenectomy alleviated the liver inflammation and fibrosis and also promoted the phenotypic switch of infiltrating macrophages to a Ly6C^low phenotype in fibrotic liver. The p-ERK1/2 expression was upregulated in macrophages at the same time. Furthermore, splenectomy increased the percentage of Ly6C^low macrophages and decreased the percentage of Ly6C^high macrophages both in vivo and in vitro, which was reversed by SCH772984. Conclusions: Splenectomy attenuates both the liver fibrosis and inflammation, and promotes the phenotype switch of infiltrating macrophages to an anti-inflammatory Ly6C^low phenotype by activating the ERK1/2 pathway during liver fibrosis.     

急性胰腺炎早期中医药干预与机理探析

中医药在治疗急性胰腺炎(AP)中发挥着重要作用,介绍了中医药灌胃、灌肠、中药外敷、静脉点滴、针刺等多种治疗方法的有效性,指出在疾病早期应用中医药能有助于缓解临床症状、体征,减少并发症,降低病死率。分析认为分期辨证多途径联合治疗更符合AP的发病规律。表明中医药通过降低炎症因子水平、改善肠道功能和屏障、调节免疫功能、改善血液循环,以阻断炎症的进展,发挥治疗作用。     

冠心病患者自我管理行为潜在剖面及其影响因素分析

目的 探讨冠心病患者自我管理行为的潜在分类,并分析不同类别的影响因素。方法 采用便利抽样的方法于2021年8月—2021年11月对郑州市某三级甲等医院心内科750名患者进行调查。调查内容包括一般资料、冠心病相关知识评价调查表、Champion健康信念模型量表和冠心病自我管理行为量表。采用Mplus 7.4对冠心病患者自我管理行为进行潜在剖面分析,并通过logistic回归分析潜在分类的影响因素。结果 本研究共纳入716例研究对象,平均年龄为（63.32±9.86）岁。最终识别出三个自我管理行为的潜在类别,分别为“自我管理行为较好-情绪调节无效型”（33%,n = 236）、“自我管理行为中等-急救管理缺乏型”（35%,n = 251）和“自我管理行为较差-依从管理不良型”（32%,n = 229）。Logistic回归分析得到年龄较大（OR = 2.610,95%CI:1.930～3.529）和心功能较差（OR = 2.450,95%CI:1.616～3.714）是自我管理行为的危险因素,有配偶（OR = 0.987,95%CI:0.769～.998）、受教育时间较长（OR = 0.697,95%CI:0.311～0.958）、家庭月收入较高（OR = 0.511,95%CI:0.176～0.883）、PSK - CHD得分较高（OR = 0.210,95%CI:0.089～0.497）和CHBMS得分较高（OR = 0.971,0.363～0.997）是自我管理行为的保护因素。结论 本研究确定了冠心病患者自我管理行为的三种潜在分类和预测因素,这为医务人员制定针对性的临床干预措施提供依据。     

人参固本口服液联合泼尼松治疗成人肾病综合征的疗效观察

目的:探讨人参固本口服液联合泼尼松治疗成人肾病综合征的疗效,为临床治疗提供参考。方法:选取2017年3月至2018年2月西南医科大学附属医院肾病内科收治的肾病综合征患者108例作为研究对象,随机分为对照组、观察组A(低剂量组)和观察组B(高剂量组),每组36例。对照组患者给予泼尼松治疗,初始剂量1. 0 mg/(kg·d),最大剂量60 mg/d,尿蛋白转阴或每日最大剂量服用4周后减量,每周减少10%剂量,直至调至20 mg/d,并在2个月后减量至10 mg/d,以10 mg/d维持至疗程结束。观察组A在对照组基础上,给予口服人参固本口服液治疗,每次餐前口服10 mL,2次/d,1周后减量至1次/d,继续服用1周后减量,口服5 mL/次,隔日顿服,并以此剂量维持至疗程结束。观察组B在对照组基础上,给予口服人参固本口服液治疗,每次餐前口服10 mL,2次/d,1周后减量至1次/d,并以此剂量维持至疗程结束。观察组A和观察组B的疗程均为1个月。比较3组的治疗效果。结果:3组患者在疗程结束后总治愈率有明显差别,观察组A和观察组B的总有效率分别为94. 44%、97. 22%,均优于对照组的总有效率77. 22%,差异有统计学意义(P 0. 05)。但观察组A和观察组B总有效率比较,差异无统计学意义(P 0. 05)。观察组A和观察组B患者的尿液蛋白指标和血脂水平均低于对照组,差异有统计学意义(P 0. 05)。但观察组A、观察组B的尿液蛋白指标和血脂水平比较,差异无统计学意义(P 0. 05)。观察组A不良反应发生率比观察组B低,差异无统计学意义(P 0. 05)。结论:人参固本口服液联合泼尼松治疗肾病综合征的疗效显著,明显优于泼尼松单独治疗。但临床建议使用低剂量的人参固本口服液联合泼尼松治疗肾病综合征。     

通腑泄浊法治疗危重病病人胃肠功能障碍 60例临床观察

目的 观察通腑泄浊法治疗危重病病人胃肠功能障碍临床疗效.方法 2015年1月至2018年1月于辽宁中医药大学附属医院住院并发生胃肠功能障碍的120例病人,按住院的先后顺序,按照事先由随机数确定的随机分组方法,进入观察组和对照组.观察组在西药治疗原发病基础上,加用通腑泄浊中药治疗.比较两组有效率、死亡率、APACHEⅡ评分、C反应蛋白水平.结果 观察组有效率为86.67％(52/60),对照组为71.67％(43/60),观察组较对照组高(P<0.05);而观察组死亡率为18.33％(11/60),对照组为35.00％(21/60),观察组死亡率低于对照组(P<0.05).观察组治疗前APACHEⅡ评分(23.08±7.64),治疗后为(11.79±4.13),对照组治疗前APACHEⅡ评分(22.15±8.36),治疗后为(14.76±4.81),两组APACHEⅡ评分治疗后均明显下降(P<0.05),观察组较对照组下降更明显(P<0.05).观察组治疗前C反应蛋白水平(102.87±37.06),治疗后(41.79±14.07),对照组治疗前C反应蛋白水平(105.64±38.35),治疗后C反应蛋白水平(72.86±13.74),两组C反应蛋白水平治疗后均明显下降(P<0.05),观察组较对照组下降更明显(P<0.05).结论 应用通腑泄浊法治疗危重病人胃肠功能障碍有效.