脾氨肽口服液联合依匹斯汀治疗慢性荨麻疹的临床研究

目的探讨脾氨肽口服液联合依匹斯汀治疗慢性荨麻疹的临床疗效。方法选取延安大学附属医院2016年5月—2017年5月收治的慢性荨麻疹患者121例,随机分成对照组(60例)和治疗组(61例)。对照组患者口服盐酸依匹斯汀片,2片/次,1次/d;治疗组患者在对照组的基础上口服脾氨肽口服液,10 m L/次,1次/d。两组患者均连续治疗4周。评价两组患者临床疗效,同时比较治疗前后两组患者临床症状积分、血清炎性指标和不良反应。结果治疗后,对照组的临床总有效率为83.33%,显著低于治疗组的96.72%,两组比较差异具有统计学意义(P0.05)。治疗后,两组患者瘙痒、风团数量、风团大小症状积分均明显降低(P0.05);且治疗组患者症状积分降低的更明显(P0.05)。治疗后,两组患者白介素(IL)-4、IL-10和C反应蛋白(CRP)水平显著性降低(P0.05);且治疗组患者各指标均明显低于对照组(P0.05)。治疗期间,治疗组患者不良反应发生率为6.56%,明显低于对照组患者的21.67%,两组比较差异具有统计学意义(P0.05)。结论脾氨肽口服液联合依匹斯汀治疗慢性荨麻疹临床疗效显著,同时能够显著改善炎性反应,具有一定的临床推广应用价值。     

特布他林联合复方甲氧那明胶囊治疗咳嗽变异性哮喘的临床研究

目的探讨特布他林联合复方甲氧那明胶囊治疗咳嗽变异性哮喘的临床疗效。方法选取2016年1月—2017年1月在首都医科大学宣武医院治疗的咳嗽变异性哮喘患者86例,根据治疗方案的差别分为对照组(43例)和治疗组(43例)。对照组患者口服复方甲氧那明胶囊,2粒/次,3次/d。治疗组在对照组基础上雾化吸入硫酸特布他林雾化液,5 mg/次加入生理盐水2 m L,3次/d。两组患者均治疗4周。评价两组患者临床疗效,同时比较治疗前后两组患者临床症状评分、肺功能和血清学指标。结果治疗后,对照组患者总有效率为79.07%,显著低于治疗组的95.35%,两组比较差异具有统计学意义(P0.05)。治疗后,两组患者慢性咳嗽、咳痰、咽痒和喘息急促等临床症状积分均显著降低(P0.05);且治疗组临床症状评分比对照组更低(P0.05)。治疗后,两组患者第一秒用力呼气容积(FEV1)、用力肺活量(FVC)、最大呼气流量(PEF)均显著增高(P0.05);且治疗组患者肺功能明显好于对照组(P0.05)。治疗后,两组患者血清白细胞介素-4(IL-4)、肿瘤坏死因子-α(TNF-α)和降钙素原(PET)水平显著降低,白细胞介素-10(IL-10)和干扰素-γ(IFN-γ)水平显著升高,同组比较差异具有统计学意义(P0.05);且治疗组上述指标变化明显优于对照组,两组比较差异具有统计学意义(P0.05)。结论特布他林联合复方甲氧那明胶囊治疗咳嗽变异性哮喘不仅能够有效改善临床症状和肺功能,还可改善血清相关炎性因子水平,具有一定的临床推广应用价值。     

穿龙骨刺胶囊联合骨肽注射液治疗骨质增生症的疗效观察

目的探讨穿龙骨刺胶囊联合骨肽注射液治疗骨质增生的安全性和有效性。方法选取信阳市第一人民医院在2015年6月—2016年6月收治的骨质增生患者177例,随机分成对照组(88例)和治疗组(89例)。对照组患者肌肉注射骨肽注射液,2 mL/次,1次/d;治疗组患者在对照组的基础上餐前口服穿龙骨刺胶囊,6粒/次,3次/d。所有患者均治疗28 d。评价治疗后两组患者临床疗效,同时比较两组患者治疗前后两组临床症状积分、VAS评分和不良反应发生情况。结果治疗后,对照组和治疗组总有效率分别为79.55%、96.63%,两组比较差异具有统计学意义(P0.05)。治疗后,两组患者麻木、疼痛、肿胀以及屈展困难等骨质增生临床症状积分均显著降低(P0.05);且治疗组骨质增生临床症状积分均显著低于对照组(P0.05)。治疗后,两组患者VAS评分与治疗前相比显著降低(P0.05);且治疗组VAS评分压痛指数明显低于对照组(P0.05)。治疗期间,对照组患者不良反应的发生率为15.91%,显著高于治疗组患者的5.62%,两组比较差异具有统计学意义(P0.05)。结论穿龙骨刺联合骨肽注射液治疗骨质增生临床疗效好,安全性高,具有一定的临床推广应用价值。     

痹祺胶囊联合塞来昔布治疗膝骨性关节炎的临床研究

目的探讨痹祺胶囊联合塞来昔布治疗膝骨性关节炎的临床疗效。方法选取2013年10月—2016年8月天津中医药大学第一附属医院收治的膝骨性关节炎患者85例,根据治疗方式的不同将患者分为对照组(42例)和治疗组(43例)。对照组患者口服塞来昔布胶囊,1粒/次,2次/d;治疗组患者在对照组的基础上口服痹祺胶囊,2粒/次,2次/d。两组患者治疗时间均为8周。评价治疗后两组患者临床疗效,同时比较治疗前后两组Lequesnse指数、WOMAC评分和血清炎症指标变化。结果治疗后,对照组的总有效率为73.81%,显著低于治疗组的90.70%,两组比较差异具有统计学意义(P0.05)。治疗后,两组患者Lequesnse指数和WOMAC评分均显著降低,同组治疗前后比较差异具有统计学意义(P0.05);且治疗组患者Lequesnse指数和WOMAC评分下降更显著,两组比较差异具有统计学意义(P0.05)。治疗后,两组患者血清超敏C-反应蛋白(hs-CRP)、白细胞介素-1(IL-1)、IL-6水平较治疗前均明显降低(P0.05);且治疗后治疗组患者hs-CRP、IL-1、IL-6水平显著优于对照组(P0.05)。结论痹祺胶囊联合塞来昔布治疗膝骨性关节炎临床疗效较好,能够显著改善膝关节功能,并降低血清炎症因子水平,具有一定的临床推广应用价值。     

芪骨胶囊联合骨瓜提取物注射液治疗中老年不稳定型桡骨远端骨折的疗效观察

目的探讨芪骨胶囊联合骨瓜提取物注射液治疗中老年不稳定型桡骨远端骨折的临床疗效。方法选取2015年10月—2016年12月高唐县人民医院收治的中老年桡骨远端骨折患者116例,随机分为对照组和治疗组,每组各58例。对照组静脉滴注骨瓜提取物注射液,50 mg加入5%葡萄糖溶液250 m L中,1次/d;治疗组在对照组的基础上口服芪骨胶囊,3粒/次,3次/d。两组均持续治疗4周。观察两组的临床疗效,同时比较两组治疗前后VAS评分、肿胀程度及其疼痛缓解、肿胀消除和骨折愈合的时间。结果治疗后,两组总有效率比较差异不具有统计学意义。治疗1、4周后,两组患者VAS评分和肿胀程度评分均显著降低,同组治疗前后比较差异具有统计学意义(P0.05);且治疗1周后治疗组的上述评分明显低于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,治疗组疼痛缓解时间、消肿时间以及骨折愈合时间均较对照组明显缩短,两组比较差异具有统计学意义(P0.05)。结论芪骨胶囊联合骨瓜提取物注射液治疗中老年不稳定型桡骨远端骨折能有效减轻患者疼痛和肿胀情况,缩短止痛、消肿以及骨折愈合的时间,具有一定的推广应用价值。     

穴位注射腺苷钴胺治疗腰椎间盘突出症的疗效观察

目的观察穴位注射腺苷钴胺治疗腰椎间盘突出症的临床疗效。方法选取2015年12月—2016年11月到天津市南开医院康复科就诊的腰椎间盘突出症患者58例,随机分为对照组和治疗组,每组各29例。对照组患者给予电针治疗,5次/周,10次为1个疗程。治疗组在对照组治疗基础上给予穴位注射注射用腺苷钴胺,5次/周,10次为1个疗程。两组患者均连续治疗2个疗程。观察两组的临床疗效,比较两组治疗前后JOA评分、VAS评分、Oswestry功能障碍指数(ODI)的变化情况。结果治疗后,对照组和治疗组的总有效率分别为82.76%、93.10%,两组比较差异具有统计学意义(P0.05)。治疗1、2个疗程后,两组患者JOA主观症状评分、JOA临床体征评分均较治疗前显著升高,VAS评分、ODI指数均显著降低,同组治疗前后比较差异具有统计学意义(P0.05);治疗1个疗程后,治疗组JOA主观症状评分高于对照组,VAS评分、ODI指数低于对照组;治疗2个疗程后,治疗组JOA主观症状评分、JOA临床体征评分高于对照组,VAS评分低于对照组,两组比较差异具有统计学意义(P0.05)。结论穴位注射腺苷钴胺治疗腰椎间盘突出症具有较好的临床疗效,可显著改善患者临床症状,具有一定的临床推广应用价值。     

前列舒通胶囊联合坦索罗辛治疗IIIB型前列腺炎的疗效观察

目的探讨前列舒通胶囊联合坦索罗辛治疗IIIB型前列腺炎的临床疗效。方法以2015年8月—2016年8月在南阳市中心医院进行治疗的88例ⅢB型前列腺炎患者为研究对象,根据治疗方案的差别分为对照组和治疗组,每组各44例。对照组口服盐酸坦索罗辛缓释胶囊,1粒/次,1次/d。治疗组在对照组基础上口服前列舒通胶囊,3粒/次,3次/d。两组患者均连续治疗6周。观察两组的临床疗效,比较两组NIH-CPSI评分、白细胞、最大尿流率的情况。结果治疗后,对照组、治疗组总有效率分别为79.55%、95.45%,两组总有效率比较差异有统计学意义(P0.05)。治疗后,两组疼痛不适、排尿症状、生活质量评分和NIH-CPSI评分总分均显著降低,同组治疗前后比较差异有统计学意义(P0.05);且治疗组降低得更显著,两组比较差异有统计学意义(P0.05)。治疗后,两组前列腺液中白细胞显著降低,最大尿流率显著升高,同组治疗前后比较差异有统计学意义(P0.05);且治疗组这些观察指标的改善程度明显优于对照组,两组比较差异具有统计学意义(P0.05)。结论前列舒通胶囊联合盐酸坦索罗辛缓释胶囊治疗IIIB型前列腺炎效果显著,可明显改善患者临床症状,值得临床推广应用。     

Effects of vitamin D supplementation as an adjuvant therapy in coronary artery disease patients*

Objectives: Low vitamin D status has been shown to be associated with coronary artery disease. We planned to research the effects of vitamin D₃ supplementation on the severity of coronary artery disease. Design: We investigated the effect of 0.5 μg vitamin D₃ per day in a randomized, placebo-controlled, double-blind study in 90 stable coronary artery disease patients residing in Beijing. Coronary angiography was performed before and after 6 months of treatment that took place between January and June. 25-Hydroxyvitamin D was measured by chemiluminescence assay. Coronary artery disease severity was assessed by using the SYNTAX scores. Results: In vitamin D supplementation group, there was a significant increase in mean 25-hydroxyvitamin D levels from baseline (19.9?±?9.8 ng/ml) to 6 months (35.8?±?12.1 ng/ml; p?<?0.001). At 6 months, the primary end point, a difference in the fall of SYNTAX score between the groups was ?2.5 (95% CI ?5.1 to ?0.5; p?<?0.001) under intention to treat analysis. Compared with the control group, patients treated with vitamin D₃ also had greater decreases in high sensitivity C-reactive protein and renin-angiotensin system activity (p?<?0.05). Conclusions: Vitamin D supplementation has beneficial effects on coronary artery disease; it can be an adjuvant therapy for patients with coronary artery disease.     

On the road to precision,there is more practical medicine to be implemented

Estimates are that of the annual global burden of 1.5 million new cases of breast cancer, two-thirds have hormone receptor positive tumors; a majority of these women come from low- and middle-income countries. For adjuvant patients with hormone receptor positive tumors, a major goal is identification of a “precision medicine”, implying a genomic, test whose application will allow identification of those whose systemic treatment can be hormonal therapy alone. Such tests in current use are very expensive and thus in the foreseeable future are out of reach of most women who pay out of pocket.For some time it has been evident that quantitative scoring of tumors for intensity and prevalence of tumor-cell staining for estrogen or progesterone receptor (ER or PR) expression (the commonest system was first described by Allred and thus provides “Allred” scores) gives an inexpensive measure of likelihood of response to hormonal therapies – a different predictive, precision medicine tool. Majorities of hormone receptor positive tumors (one third of all patients) have “Allred” scores of 6–8 (versus scores of 3–5) for both ER and PR and these tumor-bearing patients benefit significantly more from hormonal treatments than their lowering scoring-afflicted women. When ER and PR quantitative intensity and prevalence scoring is combined with Her-2/neu testing and careful tumor histologic grading, luminal A and B type tumors can be well-defined and gene-expression testing adds little practical predictive information.For women with hormone receptor positive tumors, high quality, cost-effective “precision medicine” is available without tumor gene-expression testing.     

Mean Platelet Volume (MPV), Platelet Distribution Width (PDW), Platelet Count and Plateletcrit (PCT) as predictors of in-hospital paediatric mortality: a case-control Study

BackgroundThrombocytopenia has been shown to predict mortality. We hypothesize that platelet indices may be more useful prognostic indicators. Our study subjects were children one month to 14 years old admitted to our hospital.AimTo determine whether platelet count, plateletcrit (PCT), mean platelet volume (MPV) and platelet distribution width (PDW) and their ratios can predict mortality in hospitalised children.MethodsChildren who died during hospital stay were the cases. Controls were age matched children admitted contemporaneously. The first blood sample after admission was used for analysis. Receiver operating characteristic (ROC) curve was used to identify the best threshold for measured variables and the ratios studied. Multiple regression analysis was done to identify independent predictors of mortality.ResultsForty cases and forty controls were studied. Platelet count, PCT and the ratios of MPV/Platelet count, MPV/PCT, PDW/Platelet count, PDW/PCT and MPV × PDW/Platelet count × PCT were significantly different among children who survived compared to those who died. On multiple regression analysis the ratio of MPV/PCT, PDW/Platelet count and MPV/Platelet count were risk factors for mortality with an odds ratio of 4.31(95% CI, 1.69–10.99), 3.86 (95% CI, 1.53–9.75), 3.45 (95% CI, 1.38–8.64) respectively. In 67% of the patients who died MPV/PCT ratio was above 41.8 and PDW/Platelet count was above 3.86. In 65% of patients who died MPV/Platelet count was above 3.45.ConclusionThe MPV/PCT, PDW/Platelet count and MPV/Platelet count, in the first sample after admission in this case control study were predictors of mortality and could predict 65% to 67% of deaths accurately.