四妙汤加味配合中药外敷治疗痛风性关节炎的临床研究

目的：探讨四妙汤加减配合中药外敷治疗痛风性关节炎的临床疗效。方法收集2010年1月至2013年8月本院就诊痛风性关节炎患者76例,按病例尾号随机分为两组各38例,两组患者治疗期间均进食低热量饮食,并加大日饮水量（＞2000 ml）,戒烟酒,禁食高嘌呤食物。对照组急性期口服秋水仙碱片、吲哚美辛肠溶片,缓解期口服双氯芬酸钠缓释片。治疗组在对照组治疗基础上加用四妙汤加味并配合外敷自拟消肿止痛散治疗。治疗7d后观察并记录患者治疗前后的中医症状积分、关节炎症状积分、症状缓解时间,红细胞沉降率（ESR）、C反应蛋白（CRP）、血尿酸（UA）、白细胞介素-1β（IL-1β）、白细胞介素-18（IL-18）。结果两组治疗后CRP、ESR[治疗组分别为（22.06±10.31）mg/L、（25.18±17.80）mm/h,对照组分别为（14.11±7.32） mg/L、（24.16±22.09） mm/h]均较同组治疗前降低[治疗组分别为（82.16±21.37）mg/L、（72.13±32.36）mm/h,对照组分别为（52.46±22.26）mg/L、（62.72±33.31）mm/h, P＜0.01],治疗组ESR低于对照组（P＜0.05）。两组治疗后IL-1？、IL-18[治疗组为（55.26±16.31）pg/ml、（187.32±50.38）pg/ml,对照组为（57.25±18.21）pg/ml、（178.49±52.60）pg/ml]均较同组治疗前[治疗组分别为（106.11±41.02）pg/ml、（398.15±132.52）pg/ml,对照组分别为（109.23±40.12）pg/ml、（397.16±141.21）pg/ml]明显降低（P＜0.01）。治疗后治疗组完全缓解时间为（4.02±2.08）d,对照组为（4.95±2.68）d,两组完全缓解时间比较,差异有统计学意义（P＜0.05）。结论四妙汤加减配合中药外敷可减少中医症状积分、关节炎症状积分,缩短症状缓解时间;降低ESR、CRP、UA水平,增强机体免疫力。     

Can acupuncture enhance therapeutic effectiveness of antidepressants and reduce adverse drug reactions in patients with depression? A systematic review and meta-analysis

BackgroundSome depressed patients receive acupuncture as an adjunct to their conventional medications.ObjectiveThis review aims to provide evidence on whether acupuncture can enhance the therapeutic effectiveness of antidepressants for treating depression, and explore whether acupuncture can reduce the adverse reactions associated with antidepressants.Search strategyEnglish and Chinese databases were searched for randomized controlled trials (RCTs) published until December 1, 2021.Inclusion criteriaRCTs with a modified Jadad scale score ≥ 4 were included if they compared a group of participants with depression that received acupuncture combined with antidepressants with a control group that received antidepressants alone.Data extraction and analysisMeta-analysis was performed, and statistical heterogeneity was assessed based on Cochran’s Q statistic and its related P-value. Primary outcomes were the reduction in the severity of depression and adverse reactions associated with antidepressants, while secondary outcomes included remission rate, treatment response, social functioning, and change in antidepressant dose. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework was used to evaluate the overall quality of evidence in the included studies.ResultsThis review included 16 studies (with a total of 1958 participants). Most studies were at high risk of performance bias and at low or unclear risk of selection bias, detection bias, attrition bias, reporting bias, and other bias. Analysis of the 16 RCTs showed that, compared with antidepressants alone, acupuncture along with antidepressants reduced the Hamilton Depression Rating Scale-17 (HAMD-17) scores (standard mean difference [SMD] ?0.44, 95% confidence interval [CI] ?0.55 to ?0.33, P < 0.01; I² = 14%), Self-rating Depression Scale (SDS) scores (SMD ?0.53, 95% CI ?0.84 to ?0.23, P < 0.01; I² = 79%), and the Side Effect Rating Scale (SERS) scores (SMD ?1.11, 95% CI ?1.56 to ?0.66, P < 0.01; I² = 89%). Compared with antidepressants alone, acupuncture along with antidepressants improved World Health Organization Quality of Life-BREF scores (SMD 0.31, 95% CI 0.18 to 0.44, P < 0.01; I² = 15%), decreased the number of participants who increased their antidepressant dosages (relative risk [RR] 0.32, 95% CI 0.22 to 0.48, P < 0.01; I² = 0%), and resulted in significantly higher remission rates (RR 1.52, 95% CI 1.26 to 1.83, P < 0.01; I² = 0%) and treatment responses (RR 1.35, 95% CI 1.24 to 1.47, P < 0.01; I² = 19%) in terms of HAMD-17 scores. The HAMD-17, SDS and SERS scores were assessed as low quality by GRADE and the other indices as being of moderate quality.ConclusionAcupuncture as an adjunct to antidepressants may enhance the therapeutic effectiveness and reduce the adverse drug reactions in patients receiving antidepressants. These findings must be interpreted with caution, as the evidence was of low or moderate quality and there was a lack of comparative data with a placebo control.Systematic review registration: INPLASY202150008.     

试论《金匮要略》妇人病治疗特色

从<金匮要略>中对<内经>"有故无殒"思想的临床运用,不同剂型和治疗手段的灵活选取等方面对张仲景治疗妇人病的特色进行概述.     

小柴胡汤加味治疗原发性肾病综合征临床分析

目的：观察小柴胡汤加味配合激素治疗原发性肾病综合征的临床疗效。方法：治疗组42例用小柴胡汤加味配合激素治疗，对照组40例单用激素治疗。结果：治疗组总缓解率83．39／6，总有效率92．8％；对照组总缓解率62．5％，总有效率82．5％，两组比较有显著性差异（P〈0．05）。结论：小柴胡汤加味治疗肾病综合征有消除水肿、蛋白尿，改善高脂血症，提高血浆蛋白作用。     

阿托伐他汀在急性缺血性脑卒中治疗中的应用效果分析

目的 分析在急性缺血性脑卒中治疗中阿托伐他汀的应用效果.方法 68例急性缺血性脑卒中患者,随机分为观察组和对照组,每组34例.对照组患者给予常规治疗,观察组患者在常规治疗基础上给予阿托伐他汀治疗.观察和比较两组患者治疗效果及治疗后血脂指标水平.结果 观察组患者治疗总有效率为94.12％,高于对照组的73.53％,差异具...     

银杏达莫注射液治疗早期糖尿病肾病临床观察

目的观察银杏达莫注射液对早期糖尿病肾病患者的血糖、尿蛋白、血流变及氧化应激等的影响。方法将尿微量蛋白排泄率30~300m g/24h的糖尿病患者60例随机分为两组,对照组28例,进行常规降血糖、控制血压、调脂等治疗;治疗组32例,在对照组治疗基础上静脉滴注银杏达莫注射液2周。比较两组治疗前后血糖、肾功能、24h尿微量蛋白排泄率、血流变、超氧化物歧化酶、丙二醛及一氧化氮水平等变化。结果治疗组治疗后24h尿微量蛋白排泄率、血流变明显改善,超氧化物歧化酶、一氧化氮水平明显升高,丙二醛水平明显降低;而对照组无明显变化。两组比较,差异有显著性意义(P<0.01)。结论银杏达莫注射液通过扩血管、抗血栓、抗自由基损伤、改善微循环等作用对糖尿病肾病产生一定的保护作用。     

复方丹参注射液治疗妊娠晚期羊水过少临床观察

目的探讨复方丹参注射液治疗妊娠晚期羊水过少的临床效果。方法 2008年1月至2009年10月产检及分娩的74例妊娠晚期羊水过少患者随机分为两组复方丹参治疗组及对照组,各37例;比较两组患者治疗前后羊水指数（AFI）和最大羊水池深度（AFD）、脐血流S/D的变化、血小板粘附率（%）及妊娠结局。结果与对照组比较,治疗组AFI和AFD升高;S/D比值下降（P〈0.05）,剖宫产率、血小板粘附率及新生儿Apgar评分≤7发生率均明显降低（P〈0.01）。结论复方丹参注射液能增加羊水量,降低脐血流阻力,改善妊娠结局。     

284例重及特重型颅脑创伤的手术疗效分析

目的 探讨重及特重型颅脑创伤不同时间的手术疗效.方法 本组284例患者全部行开颅血肿清除和/或去骨瓣减压术.其中超早期(3～6 h)手术201例,占70.8%;早期(7～12 h)手术63例,占22.2%;晚期(13～24 h)手术加例,占7.0%.结果 本组病例中3～6 h手术201例,死亡58例(28.2%);7～12 h手术63例,死亡20例(31.7%);13～24 h手术20例,死亡8例(40.0%).按出院时格拉斯哥预后评分(GOS)评估疗效:良好130例占65.7%,中残36例占18.2%,重残23例占11.6%,植物生存9例占4.5%,死亡86例占30.3%.结论 重及特重型颅脑创伤,伤势重,伤情复杂,病情变化快,病死率高;强调现场与院前抢救技术的熟练和救治系统的质量保证是成功的关键;同时要加强多器官继发性损害的治疗,预防并及时准确处理各种并发症.     

治疗窗窄药片5种分剂量准确性研究

目的了解5种治疗窗窄药片分剂量的准确性,为临床合理用药提供参考。方法应用药片切割器、剪刀、刀片对5种药片分剂量成2等份及4等份。结果 5种治疗窗窄药片中,硬度最大和最小的药片分别为氨茶碱、地高辛;直径最大和最小的药片分别为卡马西平、地高辛;厚度最大和最小的药片分别为卡马西平、地高辛。地高辛（切）、苯妥英钠（切）FW1/2和FW1/4与TW1/2和TW1/4比较差异有统计学意义（P〈0.05）;地高辛（剪）、氨茶碱（剪）、华法林钠（剪）、苯妥英钠（剪）FW1/4与TW1/4比较差异有统计学意义（P〈0.05和P〈0.01）;华法林钠（刀）FW1/2和FW1/4与TW1/2和TW1/4比较差异有统计学意义（P〈0.01）。5种药片用3种工具分剂量至少有5片超出质量差异15%,均不符合欧洲药典标准。分剂量成2等份时,应用剪刀超出平均质量15%的药片数均较其他2种方法多;分剂量成4等份时,3种方法超出平均质量15%的药片数均较分剂量成2等份时多。结论 5种治疗窗窄药片应用3种工具分剂量准确性较差,临床用药应引起足够的注意。需要调整给药剂量时,可考虑用液体制剂分剂量。     

哺乳动物中天然抗病毒RNAi的研究现状及其应用前景

RNA干扰（RNA interference,RNAi）能够特异性沉默与小干扰RNA（small interfering RNA,siRNA）互补的靶mRNA,在果蝇、线虫、植物和哺乳动物中发挥重要的抗病毒免疫功能.此文概述了抗病毒RNAi途径的发现、抗病毒RNAi的免疫机制、病毒编码的RNAi抑制子、天然抗病毒免疫RNAi在哺乳动物中的研究现状以及抗病毒RNAi的应用前景.