健脾中药配合化疗治疗晚期大肠癌临床观察

目的观察健脾中药配合化疗治疗晚期大肠癌的临床疗效。方法采用随机对照的方法进行研究设计,选取64例大肠癌患者,其中治疗组（32例）用健脾中药加化疗,对照组（32例）用单纯化疗,观察两组患者治疗后实体瘤疗效、生存质量（KPS评分）及免疫功能（NK、CD3、CD4、CD8）变化情况。结果治疗组、对照组总有效率分别为12.50%和6.25%;组间实体瘤疗效比较,差异有统计学意义（P〈0.05）。治疗组KPS评分治疗后明显升高（P〈0.05）,对照组治疗后无明显变化（P〉0.05）;组间治疗后比较,差异有统计学意义（P〈0.05）。治疗组治疗后NK、CD3、CD4水平显著提高（P〈0.05）,CD8较治疗前下降（P〈0.05）,而对照组免疫指标治疗前后差异均无统计学意义（P〉0.05）;组间治疗后比较,NK、CD3、CD8差异有统计学意义（P〈0.05）。结论健脾中药配合化疗具有明确的稳定肿瘤、提高患者生存质量和改善免疫功能的作用。     

虞坚尔辨治小儿疾病验案举隅

虞坚尔教授系上海中医药大学博士研究生导师、上海市中医药研究院中医儿科研究所所长,享受国务院特殊津贴专家,从事中医儿科临床、教学、科研工作近30载,临床经验丰富,尤其擅长治疗小儿肺系、肾系疾病。笔者有幸随师抄方,收益颇多。兹将虞老师治疗小儿疾病验案4则总结介绍如下,以飨同道。     

肝脾不和型功能性消化不良伴焦虑抑郁状态与“心”虚证候相关性研究

目的研究伴有焦虑抑郁状态的肝脾不和型功能性消化不良(FD)患者的心虚证候特点。方法采用问卷调查方法分析100例患者焦虑抑郁水平、脾胃症状评分、生活质量水平与心虚证候的相关性。结果肝脾不和型FD伴焦虑抑郁状态患者普遍存在心虚证候表现,其中以心阴虚和心阳虚证候频数较多(分别为47%和24%);心虚证与脾胃症状评分、HAMA评分存在一定相关性。结论肝脾不和型功能性消化不良伴焦虑抑郁状态广泛存在"心"虚证候,提示临床辨治应兼治心。     

抑癌方对小鼠移植性肠癌作用的实验研究

目的探讨中药抑癌方对小鼠移植性肠癌的影响及其可能的作用机制。方法用CT26肠癌细胞建立小鼠肠癌移植瘤模型,分阴性对照组,中药高、中、低剂量组及化疗组,分别灌服0.9%NaC l溶液、抑癌方中药及腹腔注射氟脲嘧啶（5-FU）。每3天称小鼠体质量1次,处理后计算抑瘤率,比较各组之间小鼠体质量及瘤重;用原位末端标记法（TUNEL）检测肿瘤细胞凋亡指数（AI）,比较各组细胞凋亡率。结果在实验过程中,中药各组小鼠毛色、活动、饮食以及腹泻等一般情况好于阴性对照组。用药第6天,中药中剂量组及化疗组小鼠体质量与阴性对照组比较,差异有统计学意义（P〈0.05）;用药第9天中药中剂量组及化疗组小鼠体质量与阴性对照组、中药低剂量组比较,差异均有统计学意义（P〈0.05）;到用药结束第12天,阴性对照组小鼠消瘦最明显,中药高、中剂量组及化疗组小鼠体质量与阴性对照组比较,差异均有统计学意义（P〈0.05）;而中药低剂量组与阴性对照组比较差异无统计学意义（P〉0.05）。各用药组瘤重与阴性对照组比较,差异均有统计学意义（P〈0.05）;中药高、中剂量组及化疗组AI明显高于阴性对照组（P〈0.05）,低剂量对AI无明显影响（P〉0.05）。结论抑癌方有抑制小鼠肠癌移植瘤生长及提高荷瘤鼠生存质量的作用,可促进肿瘤细胞凋亡,这可能是抑癌方抗肠癌作用的主要机制之一。     

基于代谢组学方法的湿热证“异病同证”研究

目的：从代谢组学变化层面揭示“湿热证”异病同证的物质基础。方法：以慢性乙型病毒性肝炎、非酒精性脂肪性肝病及慢性肾小球肾炎的典型湿热证患者各30例为研究对象,以健康者30例为对照,联合选用超高效液相色谱-四极杆飞行时间质谱仪和气相色谱-飞行时间质谱仪两个代谢物检测平台,对血清样本进行全谱代谢组学检测。并运用多维统计方法对数据进行分析,以探索三种不同疾病湿热证的共性及特异性变化物质。结果：通过比较不同疾病湿热证组间代谢组学差异物质,并与健康组对照,发现肌苷、尿苷、天门冬氨酸、油酸甘油酯、乳酸盐是三种疾病湿热证的共同变化物质。结论：基于代谢组学技术发现,上述三种不同疾病的典型湿热证之间,既有反映不同疾病的差异性物质,又存在与湿热证相关的共性物质,从而在代谢水平上为中医“异病同证”理论提供了客观依据。     

疏肝饮治疗肠易激综合征的临床疗效观察

目的:观察疏肝饮对肠易激综合征(IBS)患者临床症状和生活质量的改善作用。方法:将45例患者随机分为中药组(30例)和对照组(15例),中药组口服疏肝饮煎剂,对照组口服得舒特,疗程均为8周。结果:治疗组总体疗效为83.3%,与对照组比较差异无统计学意义(P>0.05);疏肝饮能有效缓解患者腹痛、腹部不适、肠胀气及排便异常等临床症状,尤其在缓解肠胀气方面,疗效明显优于对照组(P<0.05);疏肝饮同时能显著提高患者相关生活质量,改善烦躁焦虑等不良情绪,减轻患者对自身健康状况的过度担忧,改善精神和睡眠。结论:疏肝饮能有效缓解IBS患者的临床症状,提高其生活质量。     

手捻针干预重症抑郁障碍共病失眠:证据来自多导睡眠图及血清生物标志物

ObjectiveThis study is conducted to determine effects of manual acupuncture (MA) in patients with a diagnosis of major depressive disorder (MDD) and comorbid insomnia.MethodsA total of 67 participants who met the inclusion criteria were randomly enrolled in a two-arm randomized, placebo controlled, patients-blind trial and allocated to a real-MA group (patients = 34) and a sham-MA group (patients = 33). Patients in the real-MA group were treated on ‘Five-shen acupoints’, including Sìshéncōng (四神聪 EX-HN 1), Shéntíng (神庭 GV 24), Shéndào (神道 GV 11), bilateral Běnshén (本神 GB 13), and bilateral Shénmén (神门 HT 7). Though being punctured on the same acupoints, patients in the sham-MA group were treated by a placebo acupuncture approach (Streitberger Placebo-needle). Each group received corresponding interventions every other day, three times a week for total eight weeks. Both polysomnography (PSG) and testing of serum biological markers such as neuropeptide Y (NPY) and substance P (SP) were performed at pre- and post-treatment. Additionally, the global scores of Pittsburgh sleep quality index (PSQI) and the global scores of 17-items Hamilton Depression Rating Scale (HAMD17) were used for assessing the subjective sleep and emotion experience of patients, respectively. Meanwhile, adverse effects were monitored and recorded.ResultsAfter eight-week treatment, the global scores of PSQI and global scores of HAMD17 declined significantly (both P < 0.05) in the real-MA group but not in the sham-MA group (both P > 0.05). According to the parameters of PSG, striking decline were observed in sleep latency (SL) and wake after sleep onset (WASO) and striking climb were observed in total sleep time (TST) and sleep efficiency (SE) in the real-MA group after treatment (P < 0.05, respectively) but not in the sham-MA group (P > 0.05, respectively). Additionally, there were no significant differences in awakening times (ATs) and rapid eyes movement sleep latency (REM-SL) in both two groups after treatment (both P > 0.05). Meanwhile, the expression of NPY increased significantly and the expression of SP decreased significantly in the real-MA group after interventions (both P < 0.05) while those indicators only slightly fluctuated in the sham-MA group (P > 0.05). No serious adverse event was reported in either real- or sham- MA group.Conclusion(1) MA may be a potential alternative therapy for improving MDD and comorbid insomnia (particularly in extending total sleep time and shortening wake-up duration and sleep latency) via upregulating the expression of NPY and downregulating the expression of SP; more importantly, this efficacy of acupuncture can not be replaced by sham-acupuncture acting on the same acupoints with the same treatment frequency. (2) There is insufficient evidence to prove that MA can effectively reduce the number of arousals.     

从心脑论治电针中风后焦虑障碍:随机对照试验

ObjectiveTo evaluate the differences in the clinical effect and the safety in the treatment of post-stroke anxiety disorder (PSAD) between electroacupuncture (EA) and paroxetine on the base of the heart-brain theory.MethodsA total of 70 patients of PSAD were randomized into an EA group and a medication group, 35 cases in each one. In the EA group, four acupoints were selected and divided into two pairs. In the Pair A, there were Băihuì (百会 GV20) and Fēngfŭ (风府 GV16). In the Pair B, there were Xīnshū (心俞 BL15) and Shénmén (神门 HT7). After acupuncture, the electroacupuncture apparatus was applied. The duration of needle retention was 20 min. EA was given three times a week, totally for 4 weeks. In the medication group, paroxetine tablets were administered orally, 10 mg daily in the first 4 days and 20 mg afterwards, totally for 4 weeks. Before and after treatment, as well as in the follow-up period, Hamilton anxiety scale (HAMA), Barthel index (BI) for daily life ability, and clinical global impression (CGI) were observed and the clinical therapeutic effect was evaluated separately.ResultsA total of 3 cases were dropped-out in the medication group. Finally, 35 cases in the EA group and 32 cases in the medication group were included in the analysis. Compared with the scores before treatment, the scores of HAMA and CGI-SI (severity of illness) were lower and the scores of BI were higher after treatment and during the follow-up in either the EA group or the medication group (all P < 0.05). Compared with the scores after treatment, the differences were not significant in HAMA and CGI-SI scores during the follow-up in either the EA group or the medication group (all P > 0.05). Compared with the medication group, BI score in the EA group was higher in the follow-up, indicating the statistical significance (P < 0.05). After treatment, CGI-SI score was different statistically between the EA group and the medication group (P < 0.05). There were 5 cases with adverse reactions in the EA group and 9 cases in the medication group.ConclusionsThe therapeutic effect of electroacupuncture on the base of heart-brain theory is similar to the oral administration of paroxetine in the treatment of post-stroke anxiety disorder. This therapy relieves anxious emotions, promotes the recovery of limb function and has less adverse reactions in the patients.     

疏肝饮对大鼠离体结肠纵行平滑肌条收缩的抑制作用

目的观察疏肝饮对大鼠离体结肠纵行平滑肌条收缩的抑制作用及其机制。方法制备大鼠离体结肠纵行平滑肌（CLSM）肌条,应用氯化卡巴胆碱（CCh）引起肌条收缩,再加入不同浓度的疏肝饮,观察疏肝饮对CLSM收缩的抑制作用,制作疏肝饮抑制收缩作用的量效反应曲线。在此基础上加入不同的抑制剂,观察这些抑制剂对疏肝饮作用量效曲线的影响。结果疏肝饮对CCh刺激后CLSM肌条的收缩具有抑制作用,这种抑制作用具有浓度依赖性。TMB-8组、4-AP组、Nifedipine组量效曲线变化与对照组相比较,上述指标均有显著性差异（P〈0.05）;而Apamin组、N-ethymaleimide组、Methylene blue组、L-NAME组量效曲线变化与对照组相比差异无统计学意义（P〉0.05）。结论疏肝饮对CCh刺激后的CLSM肌条的收缩有抑制作用,并呈浓度依赖性,这种抑制作用的信号分子机制可能与激活特异性钾通道、抑制胞外钙内流和胞内钙离子释放,使细胞内游离Ca2＋浓度降低有关。