参苓白术散治疗脾虚型儿童功能性便秘49例临床观察

[目的]观察参苓白术散治疗脾虚型儿童功能性便秘疗效。[方法]采用前瞻性设计方法,对49例脾虚型儿童便秘患者使用参苓白术散,6g／次,3次／d,口服,连续治疗2周为1疗程。观察临床症状、大便性状、不良反应。治疗1疗程,判定疗效。[结果]痊愈2例,显效27例,有效16例,无效4例,总有效率为91．83％。[结论]参苓白术散治疗脾虚型儿童功能性便秘,疗效满意,无副作用,值得推广。     

脾虚证客观化研究进展

证候客观化研究一直是中医研究领域中的热点和焦点,脾虚证客观化研究取得了很大成就。本文从诊断标准、动物模型和客观指标3个方面进行综述。指出目前存在诊断标准未统一、动物模型的合理性和准确性尚需提高、缺乏特异性的客观指标、实验研究未与临床实践相结合几个方面问题,并提出相应对策。     

Noninvasive assessment of portal hypertension in cirrhosis: Liver stiffness and beyond

Liver stiffness measurement(LSM)is a good,but still limited tool to noninvasively assess complications and prognosis in patients with advanced liver disease.This review aims to consider the role of LSM for the diagnosis of portal hypertension-related complications and for assessment of prognosis in cirrhotic patients,and to highlight the drawbacks as well as some alternatives for improving the performance.Hence,this field is far from being closed,and deserves more attention.There is still a place for more carefully designed studies to find new,innovative and reliable approaches.     

强肌健力方及黄芪多糖对脾虚大鼠胃肠激素水平的影响

目的 观察强肌健力方及其有效组分黄芪多糖对脾虚大鼠血清淀粉酶(AMS)、胃泌素(Gas)和血浆胃动素(MTL)水平变化的影响,探讨强肌健力方防治脾虚证的作用机理.方法 将雄性SD大鼠随机分为正常对照组、脾虚模型组、强肌健力组、黄芪多糖组、强肌健力方去黄芪加黄芪多糖组(简称强肌多糖组),除正常对照组灌服蒸馏水外,其余各组采用大黄复制脾虚模型,分别给予强肌健力方、黄芪多糖、强肌多糖药液灌胃,连续15d.第16天从眼球眶下静脉采血,放射免疫分析法测定Gas和MTL的含量,比色法检测AMS的含量.结果 脾虚模型组大鼠血清AMS、Gas和血浆MTL含量均比正常对照显著降低(P均＜0.01);而强肌健力和强肌多糖组能使大鼠血清AMS、Gas和血浆MTL含量显著升高,与脾虚模型组比较有统计学差异(P均＜0.01),但黄芪多糖组对其影响不明显.结论 强肌健力方能改善和促进消化道机能及胃肠动力学,其作用机理与调节Gas和MTL分泌水平有关.但黄芪多糖对Gas和MTL分泌没有调节作用,需与方中其他药物联合应用方能显效.     

从脾肾阳虚论治慢性疲劳综合征

慢性疲劳综合征的发生与脾有密切的关系。慢性疲劳综合征与中医对眩晕、脏躁症、虚损等的辨证治疗相似,其病因可归纳为外感时邪、饮食失常、劳累过度,导致脏腑阴阳气血功能失调。所以,临床从脾主运化,脾胃升清降浊等机理方面研究,把慢性疲劳综合症辨证为脾虚气陷、肝脾不调、脾虚湿阻,并分别进行论治。     

To save a child's spleen: 50 years from Toronto to ATOMAC

Pediatric surgeons brought forth non-operative treatment for children with blunt spleen injury more than 50?years ago. At the time, this proposal was deemed reckless by many adult surgeons, and debate ensued for decades. Despite criticisms, pediatric surgeons refined the clinical pathways for children with spleen injury leading to current safe and efficient outcomes. These outcomes are defined by rare splenectomies, few blood transfusions, and short length of hospital stay. This review will address the role of the spleen through historical perceptions and scientific evidence. In addition, evolution of contemporary clinical pathways will be outlined.     

中药穴位贴敷调治脾胃虚弱型慢性胃炎的疗效观察

目的 探讨中药穴位贴敷调治脾胃虚弱型慢性胃炎的临床疗效。方法 选取2018年1月~12月我院收治的脾胃虚弱型慢性胃炎患者108例,均给予中药穴位贴敷进行调治,比较治疗前后临床疗效及中医证候积分变化情况。结果 治疗后,108例患者中临床控制3例,显效67例,好转33例,无效5例,总有效率为95.37%（103/108）。治疗后主要症状中胃痛、胃胀、胃部喜暖喜按、大便稀溏、乏力症状证候积分低于治疗前[（0.87±1.32）分vs（4.06±1.76）分]、[（1.30±1.43）分vs（3.61±2.11）分]、[（1.02±1.24）分vs（3.83±1.62）分]、[（0.72±1.11）分vs（2.83±1.96）分]、[（1.15±1.20）分vs（3.59±1.75）分],差异有统计学意义（P＜0.05）;次要症状中饮食减少、气短、懒言、呕吐清水、口淡症状证候积分低于治疗前,差异有统计学意义（P＜0.05）。结论 中药穴位贴敷可以减轻脾胃虚弱型慢性胃炎的临床症状,调节脾胃功能、调和气血、疏通经络、暖胃健脾,改善患者的生活质量。     

Thrombopoietic cytokines in patients with hepatitis C virus-associated immune thrombocytopenia

Objectives: Complex and multiple mechanisms are involved in the etiology of Hepatitis C virus-associated immune thrombocytopenia (HCV-ITP). Many hematopoietic growth factors affect the thrombopoiesis. The aim of this study was to clarify the interaction of the thrombopoietic factors in patients with HCV-ITP.

Methods: We selected 33 patients with HCV-ITP and 17 normal individuals. We compare serum interleukin (IL)-3, IL-6, IL-11, thrombopoietin (Tpo), stem cell factor (SCF), granulocyte-macrophage colony-stimulating factor (GM-CSF), tumour necrosis factor-α (TNFα), and spleen size between these two groups.

Results: Our study shows that Tpo, IL-6, and TNFα significantly increased in patients with HCV-ITP compared to the normal population (Tpo:122.577 vs. 40.602; IL-6: 2.175 vs. 0.943; TNFα: 2.460 vs. 1.322). IL-11 was significantly lower in the HCV-ITP group (10.829 vs. 15.042). HCV-ITP patients had a higher spleen index (21.121 vs 13.498, P?=?0.003). According to regression analysis and multiple linear regression analysis, only IL-11 had a significantly positive correlation with platelet count, while TNFα showed a negative correlation.

Discussions: Tpo and IL-6 increased in patients with HCV-ITP, suggesting a positive feedback of low platelet count. TNFα-associated immune response is suspected to have an impact on low platelet count. IL-11 is assumed to directly affect thrombopoiesis.

Conclusions: This study is the most comprehensive study to evaluate the interaction between platelet count and the important thrombopoetic factors in patients with HCV-ITP. The thrombopoietic factors clearly play an important role in HCV-ITP.