目的 分析积芎解毒方联合西药对糖尿病肾病的降糖效果及调节微炎症状态的作用.方法 将2019年4月—2021年12月收治的90例糖尿病肾病患者采用随机数字法分为2组.对照组给予常规对症治疗,中医辨证组加用积芎解毒方治疗.比较2组疗效、炎症因子[白细胞介素-17A(IL-17A)、超敏C-反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-18(IL-18)]、糖代谢及肾功能指标的差异.结果 中医辨证组总有效率高于对照组(P＜0.05).中医辨证组治疗后IL-17A、INS高于对照组,hs-CRP、TNF-α、IL-18、FBG、HbA1c、血Scr、BUN、24 hUPRO低于对照组(P＜0.05).结论 积芎解毒方治疗糖尿病肾病可减轻炎症反应,改善糖代谢、肾功能指标,提高疗效.

目的 观察中药肾衰灌肠液直肠滴入对慢性肾功能衰竭Ccr、炎症因子以及KDTA评分的影响.方法 将患者随机分为2组,对照组给予常规治疗,观察组加用肾衰灌肠液直肠滴入(生大黄50 g,煅牡蛎50 g,蒲公英30 g,枳实30 g,熟附子15 g,以50 mL、39～41℃的药物原汁滴入直肠,保留30～60 min,每日1次),对比2组临床疗效、Ccr、炎症因子以及KDTA评分情况.结果 观察组总有效率相比对照组明显升高(P<0.05);观察组治疗后Ccr相比对照组以及治疗前明显升高(P<0.05),Scr、BUN相比对照组及治疗前均明显降低(P<0.05);观察组治疗后hs-CRP、IL-6、IL-1以及TNF-α相比对照组及治疗前均明显降低(P<0.05);观察组治疗后KDTA评分明显高于对照组及治疗前(P<0.05).结论 中药肾衰灌肠液直肠滴入可有效提高慢性肾衰患者康复效果,可有效改善肾功能指标,缓解机体炎性症状,提高生活质量.

医学是一门实践性和应用性较强的学科,医学生临床实践能力的培养在医学知识与能力结构教学中占据重要地位.北京中医药大学第三附属医院中医妇科教研室建立问题导向(problem-based learning,PBL)结合模拟临床实践教学法,并在中医妇科学临床带教中应用.该方法从教学问题的设置、模拟实践剧本的编写、妇科实践项目的确定等来探究PBL结合模拟临床实践教学模式的实践.PBL结合模拟临床实践教学的效果评价方法有PBL结合模拟门诊诊疗评分、PBL教学结合病房情景模拟教学评分、妇科检查评分、刷手及消毒考核评分.结合教学实践对该教学模式的实施效果进行评价.PBL结合模拟临床实践教学法应用于中医妇科学临床带教具有较好的效果.

Objective: To examine the short-term outcomes of modified load-sharing rip-stop repair (mLSRS) and suture-bridge repair (SB) for large rotator cuff tear. Methods: The clinical data of patients who underwent shoulder arthroscopy for large rotator cuff repair at Department of Orthopedic, China Academy of Chinese Medical Sciences Wang Jing Hospital from January 2017 to December 2018 were collected. Totally 111 patients (39 in mLSRS group and 72 in SB group) were included in the study. There were 45 males and 66 females, aged (58.0±6.9)years (range: 40 to 72 years).A total of 39 pairs of patients were successfully matched by propensity score matching. The pain of shoulder joint was assessed by visual analogy score (VAS) , the shoulder function was assessed by Constant-Murley score, the abduction strength of bilateral shoulder joint was assessed by 90˚ force assessment method of upper limb on the plane of scapula, and the healing of rotator cuff on the operative side was assessed by sugaya ultrasonic classification standard. The difference of short-term outcome between the two groups were compared using t test, χ(2) test, Mann-Whitney U test, repeated measures design anova and multivariate analysis of variance. Results: At the 4th week after surgery, the VAS of mLSRS group was significantly lower than SB group(1 (2) vs. 2 (2) , F=5.32, P=0.02). One year after surgery, Constant-Murley score of two groups were significantly higher than those before surgery, but there was no significant difference between two groups(89.1±5.7 vs. 87.6±7.3, t=1.00, P=0.32). Abductor strength of affected limbs were lower than that of the opposite side, but there were no statistically significant differences between two groups(4.28±1.61 vs. 4.54±1.64, t=-0.70, P=0.49). According to the Sugaya classification, 32 cases in mLSRS group were healed while 7 cases were not healed,30 cases in SB group were healed while 9 cases were not healed(χ(2)=0.32, P=0.58). Conclusion: The use of mLSRS fixation construct on large rotator cuff tear can reduce pain and the short-term outcome is reliable.

笔者协助术者对1例右侧肩袖损伤患者进行肩关节镜下手术治疗过程中,发现胸小肌止点I型变异1例,此前胸小肌止点变异均发现于尸体解剖过程中,本例首次于活体发现该变异,为提供影像学相关资料,现报道如下.

目的:观察复方积雪草颗粒积芎解毒方对糖尿病肾病大鼠模型血液生化指标及对肾组织单核细胞趋化因子(MCP-1)、补体C5b-9、血管紧张素-Ⅱ(Ang Ⅱ)水平的影响,探讨积芎解毒方对糖尿病肾病大鼠的肾保护作用和可能机制.方法:60只雄性SD大鼠随机分为正常对照组、模型对照组、中药高剂量组、中药中剂量组、中药低剂量组、福辛普利组.每组10只,除正常对照组外采用高脂饲料喂养加STZ腹腔注射制作糖尿病肾病大鼠模型,治疗8周后,检测大鼠24h尿蛋白定量(UTP),血清总蛋白(TP)、白蛋白(Alb)、尿素氮(BUN)、肌酐(Scr)、谷丙转氨酶(ALT)、谷草转氨酶(AST)的变化;Real time PCR法检测各组大鼠肾组织MCP-1、C5b-9、Ang Ⅱ的表达情况.结果:与正常对照组比较,模型对照组大鼠肾组织MCP-1、C5b-9、Ang Ⅱ mRNA水平显著升高(P＜0.01);与模型对照组比较,各治疗组24 h尿蛋白定量(UTP)明显下降;TP、Alb均明显升高;MCP-1、C5b-9、Ang Ⅱ mRNA水平均明显降低,其中中药高剂量组小于低剂量组(P＜0.05),与福辛普利组相似(P＞0.05),中药低剂量组与中剂量组结果差异无统计学意义(P＞0.05),高剂量组与中剂量组差异有统计学意义(P＜0.05).各组ALT、AST、BUN、Scr变化不明显.结论:积芎解毒方高剂量对糖尿病肾病大鼠的肾保护作用可能与通过降低炎症反应从而延缓肾功能发展有关.

目的:探讨多囊卵巢综合征(PCOS)中医证型与性激素及卵巢体积、腰臀比、体质量指教、饮食偏好的相关性,为多囊卵巢综合征的中医辨证分型提供客观指标.方法:对98例PCOS患者进行中医辨证分型、检测性激素6项、妇科超声、应用方差分析、Logistic回归模型探讨不同中医证型PCOS与性激素、卵巢体积、腰臀比、体质量指数、饮食偏好的相关性.结果:肾虚型LH较高,痰瘀互结型FSH较高,肾虚型E2较高,脾虚痰湿型T较高但差异无统计学意义;肾虚型LH /FSH比值较高,脾虚痰湿型BMI、WHR值较高,卵巢体积较大差异有统计学意义;肾虚型PCOS与LH/FSH比值具有相关性,脾虚痰湿型PCOS与BMI、WHR、卵巢体积、饮食偏好具有相关性,痰瘀互结型与饮食偏好、BMI具有相关性.结论:肾虚型PCOS与黄体生成素/卵泡刺激素具有相关性,与黄体生成素、卵泡刺激素、雌二醇、孕酮、睾酮、卵巢体积无相关性,脾虚痰湿型与卵巢体积、体质量指数、腰臀比、饮食偏好具有相关性,痰瘀互结型与饮食偏好、BMI具有相关性.

目的:观察积芎解毒方对糖尿病肾病大鼠肾组织NF-κB、AngⅡ表达的影响.方法:将雄性SD大鼠随机分为正常对照组、模型对照组、中药高剂量组、中药中剂量组、中药低剂量组、福辛普利组.除正常对照组外采用STZ腹腔注射制作糖尿病肾病大鼠模型,8周后检测大鼠24 h UTP,Real time PCR及Western Blot法检测大鼠肾组织NF-κB、AngⅡmRNA和蛋白的表达情况.结果:与正常对照组比较,模型对照组大鼠肾组织NF-κB、AngⅡmRNA和蛋白的表达显著升高;与模型对照组比较,各治疗组24 hUTP明显下降,NF-κB、AngⅡ和蛋白表达均明显降低.结论:积芎解毒方高剂量对糖尿病肾病大鼠的肾保护作用可能与通过降低炎症反应从而延缓肾功能发展有关.

王庆国教授为当代名医刘渡舟教授的大弟子,其在继承刘渡舟伤寒学术思想的基础上,结合自身临床经验及现代医学知识,在妇科病方面见解独特.王师非常重视辨证论治,并主张辨证与辨病相结合.现举其辨治痛经三则,以馈同仁.

多囊卵巢综合征 (PCOS) 是以长期无排卵及高雄激素血症为特征的内分泌疾病, 本病临床上常表现为月经稀发、量少, 甚或闭经、不孕、多毛、肥胖、痤疮、黑棘皮症等, 中医古籍中并无对此病的记载.但根据多囊卵巢综合征的临床症状属于"月经后期""闭经""不孕""癥瘕"等范畴.导师刘昭阳教授对治疗多囊卵巢综合征有其独到经验, 认为本病的主要病机为肾虚血瘀, 以补肾化瘀、周期治疗立法, 运用补肾化瘀方治疗屡获良效.

目的 分析加味琥珀散治疗50例肾虚血瘀型子宫内膜异位症患者的疗效.方法 对50例肾虚血瘀型子宫内膜异位症患者治疗前后的中医症候评分、血清CA125水平、痛经症状积分、卵巢子宫内膜异位囊肿大小进行统计分析.结果 采用加味琥珀散治疗子宫内膜异位症治愈3例(6％),显效25例(50％),有效21例(42％),无效1例(2％).治疗后3个月受孕率为10％.治疗后中医症候积分、CA125水平、痛经程度、卵巢囊肿大小都较治疗前显著下降(P<0.05).结论 加味琥珀散治疗子宫内膜异位症具有显著性疗效.

在规范化培训期间加强住院医师医患沟通能力培养,对改善医患关系紧张局面具有重要意义.本文从肾病科临床疾病特征、参加规范化培训住院医师医患沟通存在的主要问题以及提高医患沟通能力的措施等方面,探讨如何在中医药大学附属医院肾病科规范化培训中加强住院医师医患沟通能力培养.

目的:观察康复新液联合保妇康栓治疗慢性宫颈炎伴人乳头状瘤病毒(human papilloma virus,HPV)感染的临床疗效.方法:将315例患者按随机数字表法分为对照组158例和研究组157例.对照组采用保妇康栓治疗,研究组在对照组治疗基础上加用康复新液湿敷外治.两组患者均以每月用药10次为1个疗程,共治疗3个疗程.比较两组慢性宫颈炎伴HPV感染的治疗效果和HPV转阴情况.结果:研究组临床有效率为89.17％高于对照组的66.46％,差异有统计学意义(P＜0.05);研究组HPV转阴率为81.53％高于对照组的60.13％,差异有统计学意义(P＜0.05).结论:康复新液联合保妇康栓治疗慢性宫颈炎伴HPV感染疗效显著,且能促进HPV转阴,有阻断子宫颈上皮内瘤变及癌变的作用.

目的:观察琥珀散对子宫内膜异位症(EMs)模型大鼠异位病灶生长的抑制作用,及对在位和异位内膜组织肿瘤坏死因子α (TNF-α)、白细胞介素(IL)-6、IL-1表达的影响.方法:将54只SD大鼠随机分为空白组,疾病模型组,琥珀散高、中、低剂量组,达那唑组,每组9只,除空白组外,其余各组均采用自体腹壁移植法建立EMs模型,连续给药3周后取材.观察大鼠异位病灶大小及形态,免疫组化法测定各组内膜TNF-α、IL-6、IL-1的表达.结果:与疾病模型组比较,琥珀散各剂量组及达那唑组干预后异位病灶体积显著减小(P＜0.01,P＜0.05).与空白组比较,疾病模型组在位、异位内膜组织TNF-α、IL-6、IL-1的表达均显著升高(P＜0.01).与在位内膜疾病模型组比较,琥珀散高、低剂量组TNF-α表达显著降低(P＜0.01,P＜0.05),琥珀散各剂量组IL-6表达均显著降低(P＜0.01,P＜0.05),琥珀散高、中剂量组IL-1表达显著降低(P＜0.01),达那唑组TNF-α、IL-6、IL-1表达均显著降低(P＜0.01).与异位内膜疾病模型组比较,琥珀散高、中剂量组TNF-α表达显著降低(P＜0.01,P＜0.05),琥珀散高、中、低剂量组IL-6、IL-1表达显著降低(P＜0.01),达那唑组异位内膜IL-6、IL-1表达显著降低(P＜0.01).结论:EMs模型大鼠在位和异位内膜组织中TNF-α、IL-6、IL-1呈现高表达,推测在位和异位内膜组织中炎性因子的增加有可能促进了EMs的发生发展.琥珀散可以降调EMs大鼠在位及异位内膜组织中TNF-α、IL-6、IL-1的表达,调节免疫机制,从而发挥治疗作用的.

目的:观察积芎解毒方对糖尿病肾病模型大鼠血液生化指标及对肾组织核因子KappaB(nuclear factor Kappa B,NF-κB)、转化生长因子β1(transforming growth factor β1,TGF-β1)、血管紧张素-Ⅱ(Angiotensin-Ⅱ,AngⅡ)水平的影响,探讨积芎解毒方对糖尿病肾病大鼠肾脏的保护作用和可能机制.方法:60只雄性SD大鼠随机分为正常对照组、模型对照组、中药高剂量组、中药中剂量组、中药低剂量组、福辛普利组,每组10只.除正常对照组外,其余各组大鼠采用高脂饲料喂养加STZ腹腔注射制作糖尿病肾病大鼠模型.治疗8周后,检测大鼠24小时尿蛋白定量,血清总蛋白(total protein,TP)、白蛋白(albumin,ALB)、尿素氮(urea nitrogen,BUN)、肌酐(serum creatinine,Scr)的变化.用ELISA法检测肾皮质组织匀浆NF-κB、TGF-β1、AngⅡ的水平.结果:与正常对照组比较,模型对照组大鼠肾脏组织NF-κB、TGF-β1、AngⅡ含量水平显著升高(P＜0.01);与模型对照组比较,各治疗组24小时尿蛋白定量(24-hour urinary protein,24hUP)明显下降(P＜0.05),TP、ALB均明显升高(P＜0.05),NF-κB、TGF-β1、AngⅡ含量水平均明显降低(P＜0.05);中药高剂量组以上指标优于中药低剂量组、中剂量组(P＜0.05).结论:积芎解毒方可降低糖尿病肾病模型大鼠NF-κB、TGF-β1、AngⅡ水平,保护大鼠肾脏功能,其作用机制可能与减轻炎症有关.

目的:探讨传统教学法与四联教学法对提高中医外科学教学质量的效果.方法:选取河南中医药大学第二临床医学院2012级中医本科1班60名学生为研究对象,随机分为观察组和对照组.观察组应用四联教学法进行教学,对照组应用一般传统教学方法进行教学.学期结束后进行成绩统计,进行教学效果评价.结果:观察组的考试平均分为(85.23±3.36)分,对照组为(72.86±4.25)分(P＜0.05).观察组97.20％的人认为四联教学法能够提高自身的综合素质,提高处理问题的能力;95.00％的人支持四联教学法,认为能够提高分析问题、解决问题和独立思考的能力,能够提高学习兴趣;94.40％的人认为四联教学法对自己的语言表达能力有很大提升,对临床处理能力有很大提高,能够促进自己的学习.结论:四联教学法用于中医外科学教学,效果明显高于传统教学方法,能够提高学生的综合素质和教学效果.

Objective:To investigate the influence of coagulant function,ET-1 and CGRP in diabetic nephropathy patients with Qi and Yin deficiency and blood stasis by Yishen Huoxue Decoction and provide the basis for treatment of early diabetic nephropathy.Methods:Ninety-four diabetic nephropathy paticnts with Qi and Yin deficiency and blood stasis from February 2010 to March 2015 in our hospital for the treatment were selected.According to the treatment,they were divided into two groups.The control group was given treatment of gliquidone and Novolin 30R.On the basis of control group,research group was given Yishen Huoxue Decoction.After treatment of 3 months,the clinical effiects of two groups were evaluated.The renal function,blood glucose,ET-1 and CGRP and coagulation function before and after treatment were compared between two groups and reactions in the treatment process were observed.Results:(1) The total effective rate in research group was 80.85％,which was higher than the control group's 61.70％ (P ＜0.05).(2) 24 h urinary micro protein,serum creatinine,blood urea nitrogen,the bladder inhibition C,homocysteine,fasting blood sugar,2 h postprandial blood glucose and glycosylated hemoglobin after treatment reduced in research group (P ＜ 0.05).The difference before and after treatment in research group was significantly bigger than that in control group (P ＜ 0.05).(3) ET-1 after treatment was reduced and CGRP increased (P ＜ 0.05) and the difference of ET-1 and CGRP before and after treatment in research group was significantly bigger than that in control group (P ＜ 0.05).(4) After treatment,fibrinogen (FIB) in the two groups was in the lower and part activated clotting time (APTT) live enzymes increased (P ＜ 0.05) and the difference of FIB and APTF before and after treatment in research group was significantly bigger than that in control group (P ＜ 0.05).(5) In the process of treatment,harmful response did not appear in two groups.Conclusions:The effect of Yishen Huoxue Decoction in treatment of diabetic nephropathy patients with Qi and Yin deficiency and blood stasis is good.Yishen Huoxue Decoction can effectively improve kidney function and blood sugar,which may be related to regulating blood coagulation function,plasma endothelin and calcitonin gene related peptide.

Objective To Discussion on Shengjiyuhonggao influence endothelial function decoction on diabetic foot,which proved Shengjiyuhonggao action mechanism of Decoction on diabetic foot.Methods Selected 50 cases of diabetic foot patients and 50 healthy control group.To observe the changes of vascular endothelial function before treatment and after treatment.SPSS16.0 for windows software was adopted for statistical treatment.Results Severe endothelial dysfunction exists in the diabetic foot,Shengjiyuhonggao have a good effect on Endothelial Function.Conclusion Shengjiyuhonggao can repair endarterectomy by affection of related factors to treat diabetic foot.

目的 探索更加有效的临床思维教学模式.方法 采用单独开设临床思维教学课程的方式进行教学,并对其教学质量进行评价研究.结果 新型临床思维教学模式锻炼了学生临床思维能力,增强了学生对学习的积极主动性,提高了学生的理解能力.结论 新型临床思维教学模式的实践具有十分的必要性.

从肾病内科临床疾病特征、中医院校医学生医患沟通存在的问题、肾病内科临床教学中培养医患沟通能力的措施等方面,探讨在中医药大学附属医院肾病内科临床教学中如何加强医学生医患沟通能力培养.