中药加心理疏导治疗围绝经期与绝经后期综合征的临床观察

绝经期妇女因卵巢功能衰退直至消失引起的内分泌失调和自主神经紊乱而出现的一系列症状称为围绝经期或绝经后期综合征。中医称之为经断前后诸症或绝经前后诸症。其为妇科常见病，发病率为85％左右，笔者在中国中医研究院西苑医院妇科进修期间，对姜坤主任医师运用中药及心理疏导综合疗法治疗妇科疾病收益颇多，现仅就其在治疗本病的病例观察报导如下：     

综合性医院肺结核诊断和治疗问题

目的 通过回顾性的分析1980～2004年因诊断肺结核住院或出院诊断肺结核病人，总结和分析历年来肺结核的流行病学、诊断与鉴别诊断及治疗的成功与失败；以了解综合性医院存在的肺结核诊断和治疗问题。方法 回顾分析和比较住院肺结核患者在80年代前、后期及90年代前、后期和20世纪的发病率、发病年龄、发现方式、临床表现、出入院诊断的符合率、合并症、实验室检查及X线特点和治疗方案等。结果 1980～2034年共收住因诊断肺结核住院或出院诊断肺结核病人共1636例。最终确诊肺结核有1577例患者，其中男性1144例，女性433例，男女之比约为2．9：1。80年代病人总数为717例，90年代病人共有538例，20世纪的发病人数为322例；两时代相比有明显减少（P〈0．01）；但在年龄分层上，老年病人发病率逐年上升，结核病的发病年龄明显后移；因症就诊发现1529例（96．96％）；其中咯血474例（30．93％），高热咳嗽443例（28．96％），低热盗汗566例（37．05％）。841例病人分别送晨痰作结核菌涂片检查3～9次，阳性181例（21．52％）：563例送验痰结核菌培养，阳性118例（20．96％）；1577例病人中有698例（44．26％）病人同时合并其他疾病如细菌感染、糖尿病、肺癌、肾病、高血压、SEE、COPD、IPF、贫血等。其中主要合并细菌感染有235例（33．67％），合并糖尿病208例（29．78％）；在确诊的肺结核1577患者中，主要类型以Ⅲ型继发性肺结核为主，共850例（53．90％），其次为Ⅳ型结核性胸膜炎492例（31．20％），Ⅱ型血源播散型有110例（6．98％），Ⅰ型为8例（0．51％），Ⅲ＋Ⅳ型有57例（3．61％）。Ⅱ＋Ⅲ有43例（2．73％）；Ⅰ＋Ⅱ有17例（1．08％）；1577例肺结核患者中，出入院诊断符合率仅71．46％（1123例），因肺炎入院有235例（14．90％），而诊断肺部肿块或肺癌的有92例（5．83％）；因两肺弥漫性疾病入院后确诊为肺结核有67例（4．25％）；有71例（4．50％）入院诊断为肺结核后经检查为非结核病。所有肺结核患者中，初治病人为大多数，有1120例（71．02％），复治病人有457例（28.98％），在复治病人中绝大多数为〉60岁，约占病人的92．56％（423／457）。在80和90年代及20世纪相比，初治病人越来越多。结论 初诊于综合性医院的肺结核病人愈来愈多，而综合性医院的痰检率很低，阳性率更低，病人来源复杂，诊断率低，合并症多，综合性医院存在的肺结核诊断和治疗问题需要引起重视，并逐步规范。以减少复治病例，提高治愈率。     

己酮可可碱在胰腺炎并发急性肺损伤中的作用

雨蛙素诱导的大鼠急性胰腺炎具有ＡＲＤＳ样急性肺损伤。用羟基脲耗竭中性白细胞、超氧化物歧化酶（ＳＯＤ）、过氧化氢酶（ＣＡＴ）清除氧自由基或应用能减少肺内中性白细胞聚集及减少氧自由基产生的己酮可可碱（Ｐｅｎｔｏｘｉｆｙｌｌｉｎｅ）后、发现雨蛙素诱导的急性胰腺炎，其肺湿重，肺微血管通透性较雨蛙素组均明显降低（Ｐ＜０．０５）。肺形态学检查无雨蛙素组的中性白细胞聚集、间质内水肿、肺泡内出血表现。它们对胰腺炎无明显保护作用。提示，中性白细胞及其衍生的氧自由基是胰腺炎并发急性肺损伤的重要介质。     

COMPARISON OF HIGH-FREQUENCY OSCILLATION VENTILATION WITH CONVENTIONAL MANDATORY VENTILATION IN ANIMAL ARDS MODEL

To compare effect of high-frequency oscillation ventilation （HFOV） and conventional mandatory ventilation （CMV） on lung injury development in rabbit with acute respiratory distress syndrome （ ARDS）. Methods Animals that underwent saline lung lavage to produce lung injury were randomized to one of the two treatment groups （ HFOV or CMV, n =6）. PaCO2 was maintained between 35 -45mmHg and arterial oxygen saturation （ SaO2 ） was maintain 〉 88% by adjusting corresponding ventilator parameters. Ventilation period was 6h. Lung fluids were aspirated before and at the end of ventilation for cell analysis. Then the animals were euthanized, lung tissue was removed for wet/dry weight measurement, light and electron microscopic examination. Besults The difference of artery blood gas analyses（pH, PaO2, PaCO2 ） between HFOV and CMV was insignificant. The difference between HFOV and CMV in cytological examination of lung fluids, wet/dry weight measurement was also insignificant. But compared with CMV, HFOV not only reduced the area of lung injury, but also reduced lung injury score in light and electron microscopic examination. Conclusion When same artery blood gas analysis was obtained, HFOV significantly reduced lung injury development in ARDS animal than CMV. As a lung protection strategy, HFOV can be used in the treatment of ARDS.     

EOTAXIN AND EOTAXIN-2 EXPRESSION IN HUMAN BRONCHIAL EPITHELIAL CELL

Objective To study the role of eotaxin and eotaxin-2 expression by Th2 cytokine and analyze their relationship in normal human bronchial epithelial cell line-BEAS-2B cell. Methods Levels of eotaxin mRNA and protein expression in the bronchial epithelial cell line BEAS-2B cell were determined with RT-PCR and ELISA. We also used RT-PCR to evaluate eotaxin-2 expression under the regulation of Th2 cytokine IL-4 and IL-13 as well as proinflammatory agent-TNFα. Results Eotaxin mRNA expression was the highest at the time point of 12h under the stimulation of TNF-α. While Th2 cytokine IL-4 and IL-13 had the amplification effect on the expression. Eotaxin protein was also elevated with the combination stimulation of proinflammatory agent TNF-α and IL-4 in dose and time dependent manner（ P 〈 0. 01 ）. These results were also seen when the cells were stimulated by TNF-α and 1L- 13. Eotaxin-2 mRNA expression was the highest at the time point of 8h. The expression evaluated by semi-quantitative RT-PCR also elevated under the co-stimulation of TNF-α and IL-4 or TNF-α and IL-13 and it should significantly correlate with Eotaxin （ P 〈 0. 05 ）. Conclusion This study demonstrated that Th2 cytokine like IL-4 and IL-13 enhances eotaxin and eotaxin-2 expression when co-stimulated with proinflammatory agent TNF-α. These results showed that Th2 cytokines existence is the strong evidence for bronchial epithelial cells taking part in the allergic inflammation especially in eosinophils recruitment.