探讨名老中医徐志瑛教授治疗肝硬化腹水的用药规律.[方法]收集徐志瑛教授治疗肝硬化腹水患者的处方,将所得资料导入中医传承辅助平台,采用复杂系统熵聚类等无监督数据挖掘方法,对其处方用药经验进行总结.[结果]对筛选出的138首处方进行分析,确定处方中药物的使用频次,药物之间的关联规则,挖掘出8个核心组合和4首新处方.[结论]徐志瑛教授治疗肝硬化腹水,"阶段辨证、分证施治",多用健脾渗湿药、行气活血药、温阳利水药,擅用"提壶揭盖法",同时重视顾护肝阴.

1 病史摘要 患者,男,37岁,因"发现乙型肝炎阳性20 年,肝硬化5 年,腹胀1 个月"于2017年12月20日入院.患者20年前体检发现乙型肝炎表面抗原阳性.5 年前B超提示肝硬化.1 年前,口服抗病毒药富马酸替诺福韦二吡呋酯片300 mg,qd.1 个月前患者突发腹胀、尿黄,在某省级医院就诊,经过相关检查确诊为原发性肝癌、肝硬化失代偿期,予TACE术、脾栓塞术.

目的:观察补肾化瘀方抗肝纤维化作用及对Hedgehog信号通路关键分子表达的影响,探讨其可能的作用机制.方法:采用CCl4皮下注射6周建立肝纤维化模型,同时以不同剂量补肾化瘀方干预6周.全自动生化仪检测血清肝功能(ALT、AST、TBil、ALP),碱水法检测肝组织匀浆羟脯氨酸含量,HE和Masson染色观察大鼠肝组织炎症和纤维化程度,RT-PCR和Western Blot技术检测肝组织中Hedgehog信号通路关键分子Shh、Ptch-1、Gli-1mRNA和蛋白表达.结果:模型组大鼠血清ALT、AST、TBil、ALP水平较正常组显著增高(P＜0.01),肝组织炎症活动度和纤维化程度评分、羟脯氨酸含量较正常组显著升高(P＜0.01),肝脏Shh、Gli-1 mRNA和蛋白表达均显著高于正常组(P＜0.01),Ptch-1 mRNA和蛋白表达较正常组显著降低(P＜0.01);应用补肾化瘀方干预后,血清肝功能水平、肝组织炎症活动度和纤维化程度评分、羟脯氨酸含量以及Shh、Gli-1 mRNA和蛋白表达有不同程度的下降(P＜0.05,P＜0.01).结论:CCl4诱导的大鼠肝组织肝纤维化存在着Hh信号通路的激活,补肾化瘀方可能通过抑制Hedgehog信号通路的异常激活,防止肝纤维化的进一步进展.

肝纤维化是多种原因引起的慢性肝损伤之后组织修复过程中的病理改变,可能进展为肝硬化、肝功能衰竭,甚至肝癌.阻断和延缓肝纤维化的发展是治疗慢性肝病的重要策略.EMT与肝纤维化进展密切相关,EMT的逆转是纤维化得到修复逆转的关键.而EMT的发生涉及多个信号转导通路和复杂的分子机制,对此进行深入研究,以期寻找有效的干预肝纤维化的途径.

咳嗽性哮喘即咳嗽变异性哮喘,是一种特殊类型的哮喘,以慢性刺激性咳嗽为主要表现,病情易反复,迁延难愈,严重影响患者的生活质量[ 1].研究表明,咳嗽性哮喘常伴随气道慢性炎症,即由多种炎症细胞及因子介导的非特异性炎症性疾病,其中白细胞介素-8(IL-8)、转化生长因子β1(TGF-β1)等与其发病密切相关[2-3].咳嗽性哮喘治疗以糖皮质激素、支气管舒张剂为主,短期疗效显著,但停药后易反复发作[4-5].复方鲜竹沥液为祛痰中成药,具有清热祛痰、抗菌消毒功效,可减轻患者炎症因子水平,改善肺功能[6].本研究通过炎症因子和肺功能指标的比较,旨在探讨复方鲜竹沥液联合布地奈德和孟鲁司特钠治疗咳嗽性哮喘的临床疗效和安全性.

肝纤维化是肝脏慢性炎症反复的结果,其特点是细胞外基质(ECM)合成与降解失衡导致其在肝脏内过度沉积[1].在细胞和分子水平,这一过程主要表现为肝星状细胞(hepatic stellate cells,HSC)活化和转化生长因子-β(Transforming growth factor-beta,TGF-β)及其下游信号分子异常激活;Smads蛋白为TGF-β信号最重要胞内效应因子,介导其核内外的信号转导,并调节TGF-β家族的正、负反馈[2].补肾化瘀方是笔者临床治疗肝纤维化的经验方,以往研究[3]表明,该方能抗肝纤维化、改善肝组织炎症和肝功能的作用,本研究探讨补肾化瘀方对CCl4诱导肝纤维化大鼠肝组织TGF-β1及其Ⅰ受体、Smad3表达的影响.

目的 通过观察派能达胶囊对慢乙肝肝硬化患者HBeAg阴转率及IL-2水平的影响探讨其是否可增强抗病毒治疗疗效,为临床慢乙肝肝硬化的治疗提供帮助.方法 对照组用抗病毒药(拉米夫定100mg/d+阿德福韦酯10mg/d),治疗组加用派能达胶囊(2粒/次,2次/d);派能达胶囊治疗6个月,治疗结束后所有患者继续服用抗病毒药物并随访9个月.乙肝三系每3月检测1次;治疗前及治疗结束时检测IL-2水平.结果 经派能达胶囊治疗的患者治疗结束后的第6个月及第9个月,HBeAg阴转率高于对照组(P＜0.05);治疗后治疗组IL-2水平高于对照组(P＜0.05);治疗后治疗组IL-2水平较治疗前显著升高(P＜0.05).结论 派能达胶囊可与西药联合应用于慢乙肝肝硬化患者,提高HBeAg阴转率,提高抗病毒疗效,为今后治疗慢乙肝及乙肝肝硬化提供安全有效的新方案.

目的:观察银杏叶提取物(GbE)对肝纤维化大鼠肝组织内质网应激相关c-jun氨基末端激酶(JNK)通路的影响,探讨GbE抗肝纤维的作用机制.方法:采用40％的CCl4皮下注射(3mL·kg-1·d-1,2次/周,首剂加倍),连续6周诱导大鼠肝纤维化模型,同时分别以低、中、高剂量(50、100、200mL·kg-1·d-1)GbE灌胃干预6周,空腹取肝组织,Real-time PCR法检测JNK mRNA表达,Western blot技术检测大鼠肝组织中JNK通路关键分子凋亡信号调节激酶(ASK)及JNK的总蛋白及其磷酸化表达.结果:肝组织JNK mRNA表达及ASK、JNK总蛋白活化水平较正常组明显增强(P＜0.05,P＜0.01);GbE低、中、高剂量组大鼠肝组织JNK mRNA表达及ASK、JNK总蛋白活化水平较模型组不同程度下降(P＜0.05,P＜0.01).结论:CCl4诱导的肝纤维化大鼠肝脏内质网应激相关的JNK通路被激活,GbE可通过调节肝纤维化大鼠JNK通路防止肝纤维化的进展.

Objective To observe the effect of Painengda on peripheral blood cell count and symptoms of patients with Chronic Hepatitis B and Liver fibrosis,explore whether can it strengthen the curative effect of nucleoside analogues,and help in treatment of Chronic Hepatitis B and Liver fibrosis. Methods The selected 60 patients were randomly assigned to two Groups(30 patients in each group),the control group were treated by nucleoside analogues(Lamivudine 100mg and Adefovir 10mg once a day) while the treated group were treated by nucleoside analogues(the same as the control group)and Painengda,which dose was 2 pills twice a day. After 6 months,the treatment of Painengda was stopped,the treatment of nucleoside analogues going on in both of the groups. Then compared syndrome integral of two groups and compared the peripheral blood cell count of patients with low level of WBC (<4 × 109/L)and(or)PLT(<100 × 109/L). Results 1. The WBC level in the treated group was obviously enhanced than in the control group(P<0.05);2. The PLT level raised in each group after therapy,but there were no statistical differences in each group itself or between the two groups;3. The syndrome integral decreased in both of the two groups after treatment(P<0.05),while the treated group ’s lower(P<0.05). Conclusion Painengda can improve the curative effect of nucleoside analogues,increase the count of WBC and PLT and improve the clinical symptoms,creating a better quality of life.

<正>慢性乙型病毒性肝炎(简称慢乙肝)是一种长期的慢性疾病,其中每年发生肝硬化和肝细胞癌为2%、1%。乙型肝炎病毒(HBV)在机体内持续感染是由病毒和机体免疫功能决定的,而Th1/Th2细胞及其产生的细胞因子比例失衡是导致乙型肝炎慢性化的重要原因。故笔者通过对轻度慢乙肝患者中医证型与细胞因子白介素-2(IL-2)、白介素-6(IL-6)、白介素-10

[目的]探讨中西医结合方法治疗肝硬化(IC)腹水的疗效。[方法]LC腹水患者62例，对照组28例，采用西医治疗；治疗组34例，西医治疗联合中医药治疗，比较两组患者的腹水消退情况。[结果]治疗组与对照组腹水消退率比较无统计学差异(P＞0.05)；治疗组腹水消退时间明显短于对照组，差异具有统计学意义(P＜0.05)。[结论]中医药在LC腹水的患者治疗中，对腹水的消退疗效显著。

BACKGROUND:Intestinal mucosa injury in cases of severe acute pancreatitis (SAP) or obstructive jaundice (OJ) is one of the main reasons for the accelerated aggravation of these diseases. Besides being an organ to digest and absorb nutrients, the intestine is also a unique immune organ. When SAP and OJ develop, the destruction of the intestinal mucosa barrier is an important contributing factor for the development of bacterial translocation, systemic inflammatory response syndrome, and multiple organ dysfunction syndrome. It is important to protect the intestinal mucosa in the therapy for SAP and OJ. In this study, we determined the effect of Radix Salviae Miltiorrhizae (Danshen) injection on apoptosis and NF-κB P65 protein expression in the intestinal mucosa of rats with SAP or OJ, and explored the protective mechanism of Danshen in their mucosa.METHODS:Sprague-Dawley rats were used in the SAP and OJ experiments. These rats were randomly divided into sham-operated, model control, and treated groups. At various times after operation, the mortality rates were calculated. Subsequently, the rats were killed to assess the pathological changes, the expression levels of Bax and NF-κB proteins, and the apoptosis indices in the intestinal mucosa.RESULTS:Compared to the corresponding model control group, the number of SAP or OJ rats that died in the treated group decreased but showed no statistically significant difference. At all time points after operation, there was no significant difference between the treated and model control groups in the staining intensity as well as the product of staining intensity and positive staining rate of Bax protein in the intestinal mucosa of SAP and OJ rats . At 3 hours after operation, the apoptosis index of the intestinal mucosa of SAP rats in the treated group was lower than that in the model control group (P<0.01). At 12 hours after operation in SAP rats and 28 days after operation in OJ rats, the staining intensity as well as the product of staining intensity and positive staining rate of NF-κB protein of the intestinal mucosa in the treated group were lower than those in the model control group (P<0.01).CONCLUSION:Danshen exerts protective effects on the intestinal mucosa of SAP and OJ rats perhaps by inhibiting apoptosis and down-regulating NF-κB protein.

Objective . To research the protective effects and mechanisms of Radix Astragali injection on the intestinal mucosa of rats with obstructive jaundice (OJ). Methods . The rats were randomly divided into sham-operated, model control and Radix Astragali treated group. We observed the pathological changes of intestinal mucosa, expression levels of Bax and NF-κB proteins, and apoptosis indexes in intestinal mucosa as well as serum NO, MDA and SOD contents, respectively, on 7d, 14d, 21d and 28d after operation. Results . The pathological severity score (on 7d and 14d), apoptotic indexes (on 14d) of the intestinal mucosa and serum MDA content (on 14d) of treated group were significantly lower than those in the model control group (P<.05). The serum SOD contents (on all time points) of treated group were significantly higher than those in the model control group (P<.05). The sham-operated group (on 21d) of the product of staining intensity and positive rate of Bax protein was significantly lower than model control group (P<.05). Conclusion . Radix Astragali injection could protect the intestinal mucosa of OJ rats by increasing the content of SOD, reducing the content of MDA, inhibiting the apoptosis and relieving the pathological changes of intestinal mucosa.

目的观察疏肝健脾化湿中药联合拉米夫定治疗慢性乙型肝炎的疗效。方法将我院接受治疗的慢性乙肝患者69例,根据患者是否要求中西联合治疗分为2组。治疗组36例给予疏肝健脾化湿中药联合拉米夫定;对照组33例,单用拉米夫定,2组疗程均为1年。比较2组的临床疗效。结果与治疗前比较,2组肝功能及临床症状均有不同程度改善(P<0.05);治疗组症状改善优于对照组,差异有统计学意义(P<0.05)。结论采用疏肝健脾化湿中药联合拉米夫定的治疗较单用拉米夫定对改善肝功能及临床症状疗效更显著。

目的:综述针灸在小儿脑瘫治疗中的现状。方法:从小儿脑瘫的主症及各种伴随症状的临床治疗中,总结目前针灸在小儿脑瘫治疗中的应用情况。结果和结论:针灸在治疗小儿脑瘫的主症及伴随症状方面均具有一定优势,但要完善以针灸为主要参与手段治疗脑瘫的体系,尚有一定的研究空间,应加强针灸与其它康复手段结合模式的探讨。

目的:观察穴位注射脑活素结合功能训练治疗小儿脑瘫的疗效。方法:将40例脑瘫患儿均以脑活素穴位注射并配合功能训练进行治疗,每日1次,每周5次,20次为1个疗程,3个疗程后进行疗效评价。结果:显效16例,有效21例,无效3例,总有效率92.5%结论:在功能训练治疗脑瘫患儿的基础上,进行脑活素穴位注射对小儿脑瘫有满意疗效。

目的:通过研究引导式教育对智力低下儿童智能发育的影响,从而使智力低下儿童的智能得到最大程度的发展。方法:将在成都市中西医结合医院儿童康复中心接受治疗的50例智力低下儿童进行以引导式教育为主的综合康复治疗,治疗前与治疗6个月后对患儿进行智商测定。结果:总有效率为94.00%。结论:引导式教育对智力低下儿童智能发育以及智力水平的提高是行之有效的方法,值得推广应用。

脑性瘫痪是指小儿出生前至生后1个月由各种原因引起的非进行性脑损伤综合征.该病可给患儿带来终生残疾,且治疗过程漫长,疗效也不十分满意,给患儿家庭带来极大的经济负担和精神压力.

小儿脑性瘫痪(脑瘫)患者都有因运动功能障碍和肌张力改变造成的异常姿势,治疗效果缓慢.笔者采用针刺配合功能训练提高了疗效,现总结如下.

小儿痉挛型脑性瘫痪(Cerebral Palsy,CP)往往存在运动障碍和姿势异常,给治疗带来很大困难.2001-01～2002-12,我们采用功能训练配合中药穴位渗透治疗小儿痉挛型脑性瘫痪54例,并与单纯功能训练治疗43例进行对照观察,现报告如下.