目的 观察解郁方联合认知行为疗法治疗肝郁血虚型失眠伴抑郁焦虑状态患者的临床疗效.方法 将60例肝郁血虚型失眠伴抑郁焦虑状态患者随机分成2组,每组各30例.均予以基础治疗,对照组在基础治疗上加认知行为疗法,观察组在对照组基础上加用解郁方进行治疗.比较2组临床疗效、睡眠质量、焦虑抑郁状态及中医证候积分变化情况.结果 治疗8周后,观察组总有效率93.30％显著高于对照组70.00％(P＜0.05);2组中医证候积分、失眠、焦虑抑郁状态各项指标评分比治疗前均明显降低(P＜0.05),且观察组较对照组改善程度更显著(P＜0.05).通过绘制ROC曲线分析肝郁血虚型中医证候与匹兹堡睡眠质量指数量表(PSQI)、失眠严重程度指数量表(ISI)关联结果显示PSQI方面,中医证候评分差异均无统计学意义(P＞0.05),ISI方面多梦健忘评分、情志抑郁评分敏感性、特异性高于两胁作胀评分、头晕眼花评分(P＜0.05).结论 解郁方联合认知行为疗法治疗肝郁血虚型失眠伴抑郁焦虑状态可提高睡眠质量,减少抑郁焦虑情绪,无明显副作用,值得临床推广应用.

蔡永亮教授,安徽省首届名老中医,首届江淮名医,从事临床、教学、科研工作四十余载,精于临床,专于科研,学研俱丰,善于总结经验.对失眠颇有研究,主张“从肝论治失眠”,认为临床上大多数失眠可分为五型,并自拟“解郁3号方”治疗失眠,有良好疗效.作者师承于蔡永亮教授,总结蔡教授“从肝论治失眠”经验,以期为失眠的辨证论治提供参考.

目的 观察牵正散加减治疗特发性面神经麻痹患者风寒外袭型的临床疗效.方法 选取2016年6月—2019年11月收治的特发性面神经麻痹风寒外袭型患者80例,按照随机数字表法分成对照组(40例)和观察组(40例).对照组口服泼尼松联合甲钴胺注射液治疗,观察组在对照组基础上采用牵正散加减治疗.观察两组患者的临床疗效,H-B面神经功能分级,面部残疾指数[躯体功能(FDIP)、社会生活功能(FDIS)]评分及不良反应发生情况.结果 观察组与对照组患者治疗后总有效率分别为92.50％、72.50％,差异有统计学意义(P<0.05).两组患者治疗前H-B面神经功能分级及FDIP、FDIS评分对比,差异无统计学意义(P>0.05).两组患者治疗后H-B面神经功能分级、FDIP评分均高于治疗前(P<0.05),FDIS评分均低于治疗前(P<0.05),且观察组改善程度均优于对照组,差异有统计学意义(P<0.05).两组患者治疗后不良反应发生率比较差异无统计学无意义(P>0.05).结论 牵正散加减治疗特发性面神经麻痹风寒外袭型的效果显著,可改善临床症状,促进患者快速康复.

目的 分析以精神障碍为首发症状的肝豆状核变性(Wilson病,WD)病人的临床特点.方法 回顾性分析24例以精神障碍为首发症状并最终确诊为WD的病人临床资料.结果 本组24例中最常见的精神障碍为情绪障碍,其中焦虑障碍15例(62.50％),且多伴角膜色素环(K-F环),24例(100.00％)均检查出角膜K-F环.病人发病前无明显诱因16例(66.67％),误诊20例(83.33％),误诊率高,故就诊时实验室检查及影像学检查结果多已显示铜代谢异常及相关内脏受损.实验室检查可见血清铜蓝蛋白<200 mg/L者22例(91.67％),行头颅核磁共振(MRI)扫描14例中9例异常(64.29％),24例(100.00％)B超均示不同程度的肝实质异常声像改变.临床上予以驱铜、护肝、对症及中药治疗为主,其中23例(95.83％)有效.结论 肝豆状核变性病人以精神障碍为首发者较少.此类病人精神症状明显,易掩盖其他症状、体征,临床医生应进行详细的神经科查体并完善相关检查,以减少误诊、漏诊率.

目的:探讨后循环缺血性中风脑血管造影结果与中医证型的相关性.方法:选取本院经 DSA确诊为后循环缺血性中风患者55例,并设置对照组为症状相似但经 DSA证实非后循环缺血性患者 36例,根据中医四诊合参结果确立中医证型,并与脑血管造影结果对比分析其相关性.结采:本组病例脑血管狭窄组的风痰阻络型和气虚血瘀型比例均高于脑血管正常组(P＜0.05),脑血管狭窄组所占比例为 60.4％,其中风痰阻络型和气虚血瘀型所占比例为 22.0％和16.5％;其他各组各证型之间比较,差异元统计学意义(P ＞0.05).结论:后循环缺血性中风患者脑血造影结果与中医证型有一定相关性,其中风痰阻络型和气虚血瘀型患者后循环缺血的阳性率最高,但是在后循环缺血性中风的患者中,中医证型与脑血管狭窄的程度或部位元显著相关性.

目的:观察多中心Wilson病(WD)患者在中西医结合长期驱铜治疗前后WD综合评定量表(Globle Asessment Scale,GAS)各项目评分的改变并评估其疗效,为建立疗效好、不良反应小的WD长期综合治疗方案提供循证医学依据.方法:参与研究的4个中心共纳入1001例WD确诊患者,随机分成青霉胺(PCA)组、二巯基丁二酸(DMSA)组、肝豆片组和中西医结合组(肝豆片+PCA/DMSA)4组(各组按1∶1∶1∶3平行设计,各组的条件除了治疗方案不同外,其他条件完全相同).在首次入院时、维持治疗1年时(第2次入院时)、维持治疗2年时(第3次入院时)进行GAS量表各项目(GAS-L、C、M、O项目及神经功能)评分,通过治疗前后自身比较及组间比较,评估各组患者的疗效.结果:各治疗组WD患者GAS各项目评分均较治疗前明显降低,在维持治疗2年时的疗效较维持治疗1年时更为明显,尤以中西医结合组评分改善最显著.结论:4种长期驱铜治疗方法均可改善WD患者的病情,中西医结合长期驱铜治疗的疗效更为显著,是目前WD患者长期治疗最有效的方案.

药对系用相辅相成或相反相成的两味药配伍使用以增强疗效.蔡永亮教授临证数十载,擅长运用自拟解郁方加减治疗失眠,并根据患者的自身病机特点予以辨证后加入药对治疗,效果显著.论文对蔡永亮教授治疗失眠常用药对经验进行了总结,对临床应用有一定的指导作用.

Objective:To observe the curative effect of Gandouling tablet in the treatment of Wilson's disease (WD) with intermin-gled phlegm and blood stasis syndrome.Method:Totally 76 WD patients with intermin-gled phlegm and blood stasis syndrome were randomly divided into the control group (38 cases) and the observation group (38 cases).The control group was given routine western medicine therapy,including dimercaptopropansulfonate sodium (DMPS) and zinc sulfate tablets.The observation group was given Gandouling tablet in addition to the therapy of control group.The curative effect was observed after 6 treatment courses.indexes such as traditional Chinese medicine (TCM) syndrome score,improved Goldstein classification,24-hour urine copper (u-Cu),ceruloplasmin (CP) and plasma copper (p-Cu) were recorded,the level of non-ceruloplasmin plasma copper (nCP-Cu) were calculated,and the blood cell counts,liver function and blood coagulation were detected before treatment and after treatment.Result:The TCM syndrome effective rates of control group and observation group were 60.53％ and 81.58％,respectively,with a significant difference between two groups (P ＜0.01).The clinical effective rates of the control group and the observation group were 73.68％ and 84.21％,respectively,with a significant difference between two groups (P ＜ 0.05).The nCP-Cu decreased in both groups (P ＜ 0.05),while the u-Cu increased in both groups (P ＜ 0.01),but there was no significant difference between two groups.After treatment,total bilirubin (TBIL),aspartate aminotransferase (AST) and alanine aminotransferase (ALT) decreased in both groups (P ＜ 0.01),particularly in observation group (P ＜0.05).Conclusion:Gandouling tablet can significantly regulate TCM syndrome,clinical efficacy and liver function in patients with WD with intermin-gled phlegm and blood stasis syndrome.

目的:观察解郁一号方联合盐酸帕罗西汀治疗帕金森病合并抑郁症状的临床疗效.方法:将68例帕金森病合并抑郁症状的患者纳入研究,随机分为实验组和对照组各34例,实验组给予盐酸帕罗西汀联合解郁一号方治疗,对照组给予盐酸帕罗西汀治疗,采用汉密尔顿抑郁量表(HAMD)评价治疗效果.结果:2组治疗后HAMD评分均较治疗前下降,与治疗前相比,实验组在治疗1周见效,差异有统计学意义(P＜0.05),对照组在治疗1周,差异无统计学意义(P＞0.05),2、4、6、8周末,差异有统计学意义(P＜0.05);第2、4、6、8周末,实验组HAMD评分均低于同期对照组,差异有统计学意义(P＜0.05).结论:解郁一号方联合盐酸帕罗西汀治疗帕金森病合并抑郁症状较单用盐酸帕罗西汀起效快,效果好.

肝豆状核变性(HLD)又名为Wilson病,是一种单基因、常染色体隐性遗传、铜代谢异常的疾病.突变的基因定位在染色体13q14.3.发病率3/10万,儿童大约1/50万～ 1/100万,发病年龄一般在4～20岁.可累及肝脏和肝外各组织,如脑、肾脏、角膜、骨骼、皮肤和血液系统等.由于基因突变,铜代谢障碍,过量的铜进行性沉积在体内各脏器,导致HLD患者早期症状较为复杂多样,儿童表现更不典型.对于儿童HLD,及早发现和诊治十分重要,关乎患者预后及生活质量.因此,我们就其发病机制及诊断进展做一概述.

抑郁性疾病在中医学中可归属于情志病范畴,蔡永亮教授研究认为郁证多有情志所伤致使五脏气机郁滞的病症,包括五气之郁以及情志之郁,其中五气之郁由于多种因素导致脏腑功能失调,人体气血津液不通所致;情志之郁是由于情志导致患者躯体症状的显现.在治疗中尤擅长应用花类药,自拟中药治疗抑郁性神经症,验之临床,效果颇佳.本文通过对蔡永亮教授运用花类药治疗抑郁性疾病的经验进行总结,体现中医药辨证论治的疗效优势.

目的:观察脑络欣通对后循环缺血支架术后血浆黏度、纤维蛋白原、血管支架部位血管直径变化,阐明脑络欣通对后循环缺血支架术后患者能否提高临床疗效及手术成功率,减少并发症的发生.探讨脑络欣通对后循环缺血支架术后再狭窄预防作用机制.方法:采用完全随机设计方法,将符合纳入标准的60例患者,按照随机数字表方法,随机分为治疗组30例和对照组30例.结果:手术后治疗组分别于3个月、6个月、1年患者行脑血管造影、并检测血浆黏度、纤维蛋白原观察指标.结果:治疗组在动脉狭窄率、血浆黏度、纤维蛋白原等指标作用优于对照组(P＜0.05).结论:脑络欣通对后循环缺血支架术后再狭窄预防作用效果显著,脑络欣能预防动脉内支架再狭窄,提高手术的成功率.

OBJECTIVE:To observe blood uric acid levels and Goldstein grading, as well as their correlation in Wilson's disease (WD) patients with different Chinese medical syndrome types.METHODS:Totally 906 WD patients in line with inclusive criteria were assigned to 6 groups, i.e., the heart spirit confused by phlegm group (HSCP, 26 cases), the phlegm-fire disturbing heart group (PFDH, 90 cases), the retention of damp-heat group (RDH, 113 cases), deficiency of qi and blood group (DQB, 168 cases), the deficiency of Gan-yin and Shen-yin group (DGYSY, 327 cases), the deficiency of Gan and Shen group (DGS, 182 cases) due to different Chinese medical syndrome types. Recruited were another 160 healthy subjects having similar ages and diet structures, who came for medical examinations, as the healthy control group. Venous blood was collected from the medial cubital vein of each-patient on an empty stomach in early mornings to detect blood uric acid levels. Results Blood uric acid levels were lower in each syndrome type group than in the healthy control group (146.08 +/- 67.24 micromol/L in the HSCP group; 157.08 +/- 69.77 micromol/L in the PFDH group; 162.58 +/- 97.72 micromol/L in the RDH group; 156.20 +/- 62.63 micromol/L in the DQB group; 161.83 +/- 111.23 micromol/L in the DGYSY group; 194.41 +/- 90.01 micromol/L in the DGS group; 242.39 +/- 87.55 micromol/L in the healthy control group, P < 0.01). Blood uric acid levels were higher in the DGYSY group than in the other 5 syndrome groups (P < 0.01). Correlation analyses between Goldstein grading and blood uric acid showed that, along with increased Goldstein grade (that was aggravating disease conditions), WD patients' blood uric acid levels decreased (P < 0.01).CONCLUSIONS:WD patient's blood uric acid levels decreased more. Blood uric acid levels and Goldstein grading were different in various Chinese medical syndrome types. Blood uric acid levels had certain value in assessing the severity of WD.

目的 观察依达拉奉注射液联合银杏达莫注射液治疗急性脑梗死的临床疗效.方法 93例住院急性脑梗死患者随机分为治疗组48例和对照组45例.对照组给予常规的抗血小板聚集、防治脑水肿、维持水电解质平衡、预防感染等治疗措施.治疗组给予依达拉奉注射液联合银杏达莫注射液静滴治疗;疗程均为14 d.观察两组治疗前后神经功能缺损程度评分、改良Barthel指数、改良Rankin量表、血液流变学指标和血浆纤维蛋白原水平.结果 治疗组总有效率89.83％明显高于对照组71.19％(P＜0.01),治疗组神经功能、血液流变学指标(MDA和SOD,是抗氧化指标)和纤维蛋白原含量与对照组相比有显著改善.结论 依达拉奉注射液联合银杏达莫注射液治疗急性脑梗死疗效显著,值得临床推广应用.

Objective:①To investigate the difference of liver fibrosis indexes in WD patients and normal people.②To analyze the difference of liver fibrosis indexes by comparing Wilson's disease clinical classification of Chinese and western medicine. Methods:60 cases of WD patients and 30 volunteers were included in the study. Serum HA,LN,PC Ⅲ,C-Ⅳ and other factors were measured. Results:①Compared to normal people,WD had a significant difference(P0.01)in liver fibrosis index.②The result showed that liver fibrosis index had difference between clinical classification of Chinese and western medicine.

目的:探讨中西医结合治疗对肝豆状核变性患者血清炎症因子水平的影响.方法:61例WD患者随机分为2组,WD组29例,健康对照组32例,均给予规定的低铜饮食,均予二巯基丙磺酸钠(DMPS),按照20mg/kg·d的标准加入5％葡萄糖500mL中,每天1次,6d为1个疗程;每个疗程休息2d;共计6个疗程.健康对照组同时加用肝豆灵片,每次6～8片,每天3次;共计6个疗程.分别观察治疗前后WD患者血清IL-6、TNF-α水平、药物不良反应的变化情况及临床疗效.结果:治疗后WD组、健康对照组有效率分别为69.0％、93.7％,健康对照组优于WD组(P＜0.05);2组治疗后IL-6、TNF-α水平均下降(P＜0.05或P＜0.01),且健康对照组IL-6、TNF-α水平与WD组有显著差异性(P＜0.05).WD组、健康对照组不良反应发生率分别为34.5％、和15.6％.结论:WD患者血清炎症因子IL-6、TNF-α水平异常升高;WD患者在铜代谢异常同时存在炎症反应,WD患者的组织损害与炎症反应的参与有一定的关系.肝豆灵片具有下调WD患者体内异常增高的炎因症因子水平的作用.

ObjectiveTo retrospectively observe the relation between the corneal Kayser- Fleischer(K-F) ring in Wilson's disease and their clinical classification types, the course of disease, the gender and the grade of Goldstein.Methods 924 patients which meet the entry criteria were classified as the group of liver type, brain type and brain-visceral type. Kayser-Fleischer ring was checked by empirical doctor on slit-lamp examination in darkroom.Results The K-F ring's grade in liver type of WD was significantly lower than brain and brain-visceral type (P=0.00). There had significant between K-F ring negative group and grade 2, 3, 4 of K-F ring (P=0.00), but there had not significant between group of K-F ring positive. The average of duration in K-F ring negative group was significantly lower than K-F ring positive which grade in 2, 3, 4. The duration had not significant in group of K-F ring positive. The ration of K-F ring positive and negative also had not significant in gender.Conclusions K-F ring have close relation to clinical classification types and the duration of Wilson's disease. The K-F ring grade has part relation to the grade of Goldstein scale, but not find positive correlation thoroughly. And we also have not find correlation between K-F ring and the gender in Wilson's disease.

肝豆状核变性(hepatolenticular degeneration,HLD)又称Wilson Disease (WD),是一种常染色体隐性遗传性铜代谢障碍疾病,也是少数几种可以治疗的神经系统遗传性疾病之一.目前世界各地患病率不一,据报道约为0.3～3/10万[1].在我国的发病率并不少见,朱氏等回顾性分析2001年1月-2010年12月进行肝脏活体组织病理检查的儿童非病毒性肝病703例,非病毒性肝病疾病谱为66种,以肝脏代谢相关性疾病最多(46.23％)(其中单病种以肝豆状核变性最多(48.92％))[2]. 肝豆状核变性基因突变引起的ATP7B功能缺失,可导致铜蓝蛋白合成障碍、胆汁排铜障碍、金属巯蛋白基因及其调节基因的异常以及溶酶体缺陷等生理机制异常[3],导致铜在全身各脏器的沉积,大量的铜先沉积于肝脏,当肝脏内铜饱和后,铜又可在脑、骨及肾脏等组织内沉积,从而引起一系列脏器病变[4].

<正>肝豆状核变性(hepatocellular degeneration,HLD)又称Wilson病(Wilson's disease,WD)是常染色体隐性遗传性铜代谢障碍性疾病,也是发病率较高的少数几种可治性遗传病之一。其发病机制是体内铜代谢障碍造成铜在体内各脏器尤以大脑豆状核、肝、肾及角膜大量沉着,造成沉积部位产生程度不等的功能与结构损害,临床表现为震颤、肌张力障碍、精神障碍、肝脾肿大、腹水等。

运用解郁一号方治疗失眠65例,并与用中成药枣仁安神胶囊治疗35例相比较,2组患者均以7d为1个疗程,3个疗程后进行疗效观察。结果治疗组有效率89.47%,对照组61.76%,2组比较经卡方检验,P<0.05,治疗组疗效优于对照组。