清代医家陈士铎与沈菊人治疗妇人血崩学术思想异同探析

阐发陈士铎、沈菊人两位医家对血崩病因病机及治法方药的异同。两位医家均重视体质的发病因素及血崩常见虚热之证。陈士铎更多关注到血崩的病因为房事不节,病机涉及脾胃亏虚、冲任不固、肝气郁结、瘀血内阻等,治疗上以气血辨证及五脏生克制化用药,同时强调血崩之人宜戒欲养生。沈菊人治疗血崩重点在中焦脾胃上,多以归脾丸加减治疗,健脾、醒脾、运脾,补益中焦,但补益之外常加麦芽等开胃之品以疏导。两位医家的学术思想特色鲜明,互补互用,通过对比研究,能够从体质、病因、病机、治法及用药等方面全方位把握血崩内涵,有助于临床辨证用药。     

不同血运重建策略对存在多支血管病变的非ST段抬高型心肌梗死患者预后影响的Meta分析

目的 系统评价不同血运重建策略对存在多支血管病变的非ST段抬高型心肌梗死(NSTEMI)患者预后的影响,以便为临床诊疗提供指导.方法 检索Pubmed、Embase、CNKI及万方数据库,收集与NSTEMI并发多支血管病变采用不同血运重建策略治疗的相关临床随机对照研究,评价纳入研究质量,提取有效数据后通过Revman ...     

黄绿青霉素对低硒低蛋白大鼠心肌损伤的初步观察

目的 观察黄绿青霉素(CIT)对低硒低蛋白大鼠心肌损伤的特点.方法 40只4周龄Wistar大鼠,雌雄符半,体质量60～80 g,按2×2析因设计随机分为常硒常蛋白无毒素组、常硒常蛋白加毒素组、低硒低蛋白无毒素组和低硒低蛋白加毒素组(将低硒低蛋白合为一种因素考虑),每组10只.分别采用常硒常蛋白和低硒低蛋白饲料喂养大鼠至第10周后,加毒素组大鼠饲料中投予CIT(5 mg·kg-1·d-1)继续喂养至第16周.观察各组大鼠的毛色、摄食、体质量增长情况,计算心脏质量指数,观察心肌病理变化,检测血清硒、白蛋白水平、肌酸激酶(CK)和谷胱甘肽过氧化物酶(GSH-Px)活性以及心肌超氧化物歧化酶(SOD)活性.结果 硒、蛋白和CIT对大鼠体质量、血清硒、白蛋白水平、心脏质量指数、血清CK、GSH-Px活性和心肌SOD活性的影响不存在交互作用(F值分别为0.000、1.210、0.625、0.981、2.785、0.074、0.001,P均>0.05);硒、蛋白对大鼠血清硒、白蛋白水平、心脏质量指数和血清GSH-Px活性的主效应有统计学意义(F值分别为507.698、87.734、4.201、109.389,P均<0.05);CIT对大鼠体质量、血清硒、白蛋白水平、心脏质量指数、血清CK活性的主效应有统计学意义(F值分别为10.929、4.371、26.108、24.844、4.439,P均<0.05).低硒低蛋白两组的血清硒水平[(70.4±40.0)、(87.7 ±59.6)μg/L]低于常硒常蛋A两组[(446.1±74.8)、(502.1±39.2)μg/L,P均<0.05];低硒低蛋白两组的血清白蛋白水平[(34.36±1.28)、(33.38±2.48)g/L]低于常硒常蛋白两组[(40.69±1.30)、(38.71±2.15)g/L,P均<0.05];相同硒和蛋白水平下,加毒素组的心脏质量指数[(4.14±0.36)×10-3、(4.39 ±0.53)×10-3]高于无毒素组[(3.56±0.26)×10-3、(3.80±0.28)×10-3,P均<0.05];低硒低蛋白加毒素组的血清CK活性[(2.54 ±0.56)kU/L]低于低硒低蛋白无毒素组[(3.37±0.67)kU/L,P<0.05].低硒低蛋白两组的血清GSH-Px活性>(408.1±412.6)、(510.5 ±392.0)U/L[低于常硒常蛋白两组[(1667.8±102.2)、(1731.5±144.4)U/L,P均<0.05].电镜结果显示,常硒常蛋白加毒素组大鼠部分心肌细胞闰盘断裂,各带连接断裂,部分区域心肌细胞有溶解现象,有水肿表现;低硒低蛋白无毒素组大鼠心肌细胞膜结构改变不明显,核周围肌丝结构消失,可见大量絮状物质沉积;低硒低蛋白加毒素组大鼠心肌细胞肌节各带结构不很清晰,核旁线粒休嵴轻度疏松,偶见空泡变,大量弥漫性肌质网扩张.结论 CIT是诱导大鼠心肌细胞损伤的主要因素,低硒低蛋白加重病变,但独立致病作用较弱.

Abstract：

Objective To ohserve the rat myocardial damage induced by citreoviridin(CIT)in the status of combined selenium and protein deficiency.Methods According to 2×2 factorial design,forty 4-week-old healthy Wistar rats were randomly divided into four groups.i.e.combined selenium and protein adequate with no CIT and with some CIT groups(Se+Pro+CIT-.Se+Pro+CiT+),combined selenium and protein deficiency with no CIT and with some CIT groups(Se-Pro-CIT-,Se-Pro-CIT+).The numbers of male and female were fifty-fifty.Theserats were fed with combined selenium and protein adequate and combined selenium and protein deficiency fodder until the 16th week. Cardiac toxicity of CIT was evaluated by general state of health, heart weight index, myocardial pathological change, the levels of selenium and the activities of glutathion peroxidase (GSH-Px) and creatine kinase (CK) in serum, and the activity of superoxide dismutase(SOD) of myocardium. Results The interaction effects of combined selenium and protein deficiency and adequate CIT on body weight, serum levels of selenium and albumin, heart weight index, the activities of CK and GSH-Px in serum and SOD of myocardium were statistically not significant(F= 0.000, 1.210, 0.625, 0.981, 2.785, 0.074, 0.001, all P> 0.05). The main effects of combined selenium and protein on the levels of serum selenium and albumin, heart weight index and the activity of GSH-Px in serum were statistically significant(F = 507.698, 87.734, 4.201, 109.389, all P < 0.05). The main effects of CIT on body weight, the levels of serum selenium and albumin, heart weight index and the activity of CK in serum were statistically significant(F = 10.929, 4.371, 26.108, 24.844, 4.439, all P < 0.05). The mean levels of serum selenium of Se-Pro- groups [(70.4 ± 40.0), (87.7 ± 59.6 )μg/L] were lower than those of Se+Pro+ groups [(446.1 ± 74.8),(502.1 ± 39.2)μg/L, all P < 0.05]. The mean levels of serum albumin of Se-Pro- groups [(34.36 ± 1.28 ), (33.38 ±2.48)g/L] were lower than those of Se+Pro+ groups[(40.69 ± 1.30), (38.71 ± 2.15)g/L, all P < 0.05]. The mean levels of heart weight index of CIT+ groups[(4.14 ± 0.36) × 10-3, (4.39 ± 0.53) x 10-3] were higher than those of CIT-groups[(3.56 ± 0.26) x 10-3, (3.80 ± 0.28) x 10-3, all P < 0.05] respectively at the same levels of selenium and protein. The mean levels of CK in serum of Se-Pro-CIT+ group[(2.54 ± 0.56)kU/L] was lower than that of Se-Pro-CIT- group [(3.37 ± 0.67 )kU/L, P < 0.05]. The mean levels of activity of GSH-Px in serum of Se-Progroups[(408.1 ± 412.6), (510.5 ± 392.0)U/L] were lower than those of Se+Pro+ groups[(1667.8 ± 102.2),(1731.5 ± 144.4)U/L, all P < 0.05]. In Se+Pro+CIT+ group, there was part of intercalary disc of cardiac myocytes fragmented;the conjunctions between myoeytes were broken;in some region, cardiac myocytes became edematous,even dissolved. In Se-Pro-CIT- group, the change of cardiac myocytes membrane structures was not obvious;filament structure was disappeared around nucleus;deposition of mass floccule could be seen. In Se-Pro-CIT+ group,the structure of sarcomeres was not obvious;mitochondrial cristae was loosened;cavities in myocytes could be seen occasionally;there were lots of disseminated sareoplasmic reticulum extending. Conclusions .CIT is the main risk factor in inducing myocardial damage. The deficiency of combined selenium and protein can aggravate the damage,but its independent pathogenic effect is weak.     

胆固醇诱导内皮细胞凋亡及抑制细胞增殖的实验研究

背景与目的:探讨胆固醇(cholesterin)对人脐静脉内皮细胞(human umbilical vein endothelial cell,HUVEC)凋亡及细胞增殖的影响,同时观察CuSO4溶液在其中所起的作用.材料与方法:实验分为8组:对照组(等体积溶剂)、胆固醇低剂量组(25 mg/L)、中剂量组(50 mg/L)和高剂量组(100 mg/L);另外4组分别为以上各组加入终浓度为10 μmol/L的CuSO4溶液.应用流式细胞仪检测不同浓度胆固醇对细胞凋亡率的影响;应用四甲基偶氮唑蓝微量酶反应比色法(MTT试验)检测细胞的生存率.结果:不同浓度的胆固醇可不同程度地诱导HUVEC细胞发生凋亡,可明显抑制HUVEC细胞增殖,且随浓度增高,其作用均明显增强.同时发现各组加入CuSO4溶液后可使其细胞凋亡率明显增加,生存率下降.结论:胆固醇可以诱导内皮细胞凋亡及抑制细胞增殖,CuSO4溶液可促进胆固醇对HUVEC的损伤作用.     

朗格汉斯组织细胞增生症的诊治进展

朗格汉斯组织细胞增生症（LCH）是一种少见的、病因尚不明确的单核-巨噬细胞异常增生性疾病,其临床表现具有多样性,累及多个系统,且发病机制复杂,目前主要认为是炎性髓样肿瘤,治疗上仍以联合化疗为主,随着靶向药物及骨髓移植应用逐渐增多,其并发症及不良反应需进一步解决。对于单系统受累LCH 患者预后较佳,临床报道治愈病例较多。而多系统受累LCH患者预后不佳,病死率高。本文就近年来有关LCH的发病机制、临床表现、诊断与治疗及预后进展进行综述。     

霍山石斛胶囊降血脂疗效的实验研究

目的以高脂血症模型大鼠研究霍山石斛胶囊(DHC)降血脂作用。方法用高脂饲料喂养大鼠4w,建立实验性高脂血症大鼠模型,而后进行低、中、高三种剂量DHC及阳性对照药血脂康实验性治疗,给药4w、6w后检测模型大鼠血清总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)含量,并计算动脉粥样硬化指数(AI);同时测定血清超氧化物歧化酶(SOD)活性、丙二醛(MDA)和一氧化氮(NO)含量。结果与高脂血症模型组相比,DHC低、中、高剂量组能不同程度地降低高脂模型大鼠血清TC、TG、LDL-C含量;升高血清HDL-C含量;升高血清SOD活性和NO含量,并降低其MDA含量,且呈量效关系,尤其以DHC中、高剂量组作用最为显著。结论适宜剂量的DHC具有明显的降血脂、保护血管内皮和抗脂质过氧化作用,对高脂血症和动脉粥样硬化的发生有一定的防治作用。     

名中医胡跃强基于“扶阳三焦次第法”论治顽固性失眠经验

总结胡跃强教授基于“扶阳三焦次第法”治疗顽固性失眠经验。胡跃强教授认为三焦阳虚是顽固性失眠的根本病因,从三焦阳虚导致心肺失降、脾胃气机失调、肝肾失升,分析顽固性失眠的发病机制。根据三焦是人体气血、水火运行的通道,是调和阴阳的关键枢机,阳气以温为用、常易亏易损等生理特点,在治法上采用“三焦次第法”即桂枝法宣通中上二焦,四逆法温固下焦,并倡导择时服药的诊疗思想,疗效显著。     

中西医结合治疗脱垂性痔盆底动力学变化60例疗效观察

目的:观察分析中西医结合治疗环状脱垂性痔手术前和手术后盆底功能动力学变化,并对排便功能各项指标记录分析疗效.方法:研究对象是2019年2月-2020年2月60例住院患者,通过术前评估排便功能各项指标,采用消痔灵注射联合弹力线套扎和或外痔切除术,在术后采取倍柏洗液熏洗坐浴加速术后康复疗法,分析治疗前后排便功能各项指标变化...     

慢性肾功能衰竭患者肺功能测定的临床意义

对87例慢性肾功能衰竭患者进行了常规肺功能测定以及动脉血气分析。结果显示慢性肾功能衰竭患者肺功能各项主要指标均显著减退。血液透析和肾移植术后肺功能则显著改善。提示肺功能测定对评估尿毒症性肺损害以及监测其发生、发展具有一定的价值。