本观察旨在探讨低频穴位电刺激联合中药外敷对宫腔粘连术后薄型子宫内膜的血流、厚度及容受性影响.现总结报道如下. 1 一般资料 选取2018年12月～2019年12月因宫腔粘连在本院行宫腔镜手术的患者共90例,采用随机数字表法分为观察组、外治组和对照组3组,每组30例.观察组平均年龄29.90±3.54岁,平均中医证候评分16.19±1.64分;外治组平均年龄30.20±4.99岁,平均中医证候评分17.12±1.01分;对照组平均年龄30.23±4.69岁,平均中医证候评分15.29±1.56分.3组一般资料比较,无统计学差异(P>0.05).纳入标准:符合宫腔粘连术后薄型子宫内膜的诊断标准;年龄在20～40岁之间;不存在异常的基础性激素水平.

目的:探讨和研究结合中医的多形式心理干预质量管理方法在心理科的应用效果.方法:将医院2019年10月—2021年10月的146例心理科患者作为研究对象,分为对照组和观察组,每组73例.对照组采用常规心理干预,观察组应用中医多形式心理干预方法进行管理,比较两组患者治疗依从性、患者对护理服务满意程度、患者的生活状态情况、患者的整体干预效果情况.结果:观察组患者治疗依从性评分高于对照组(P＜0.05).观察组患者护理服务整体满意率高于对照组(P＜0.05).观察组患者的生理健康状态评分、心理健康状态评分、社交功能状态评分均高于对照组(P＜0.05).观察组患者的干预效果总有效率高于对照组(P＜0.05).结论:医院心理科应用结合中医的多形式心理干预措施后,患者活动、协调等方面的治疗依从性有较大程度的提高,同时也提高了患者的满意度.

目的 探讨补肾养血安胎汤联合地屈孕酮对先兆流产患者总三碘甲状腺激素(TT3)水平、血清雌二醇(E2)水平及继续妊娠率的影响.方法 选取2018年11月-2019年11月宁波市中医院收治的110例先兆流产患者随机分为研究组和对照组各55例,对照组给予地屈孕酮治疗,研究组在前者基础上给予补肾养血安胎汤治疗.观察并对比两组治疗总有效率、治疗前后甲状腺功能[TT3、总四碘甲状腺激素(TT4)、促甲状腺激素(TSH)]水平、治疗前后患者雌激素水平[孕酮(P)、E2、人绒毛膜促性腺激素(hCG)]、治疗前后细胞因子[白细胞介素-2(IL-2)、白细胞介素-10 (IL-10)]水平以及患者继续妊娠率、临床症状缓解时间.结果 研究组治疗总有效率及继续妊娠率分别为96.36％、92.73％明显高于对照组的78.18％、70.91％,差异有统计学意义(P＜0.05).治疗前两组患者血清TT3、TF4、TSH、P、E2、hCG、IL-2、IL-10水平比较差异无统计学意义(P＞0.05);治疗后两组患者血清TT3、TF4、P、E2、hCG、IL-10水平较治疗前均明显升高且研究组明显高于对照组,血清TSH、IL-2水平较治疗前明显降低且研究组明显低于对照组,差异均有统计学意义(P＜0.05).治疗后研究组临床症状缓解时间较对照组明显缩短,差异有统计学意义(P＜0.05).结论 补肾养血安胎汤联合地屈孕酮治疗先兆流产效果较好,可有效改善甲状腺功能,降低炎性水平,促进雌激素分泌,提高先兆流产患者继续妊娠率,缩短临床症状缓解时间,具有一定临床推广价值.

Objective:To construct and evaluate a predictive diagnosis model of Alzheimer′s disease(AD) based on serum microRNA (miRNA).Methods:Downloaded the serum miRNA chip data of 1 021 AD patients and 288 healthy controls from the gene expression omnibus (GEO) database, a total of 1 309 samples were obtained. Matched AD patients and healthy controls by age, and screened out 494 samples for training and verifying the diagnostic model. Sorted the miRNA expression value from high to low and selected the top 1 000 probes for the next step. According to the ratio of 7∶3, all 494 samples were randomly divided into a training group and a validation group. LASSO regression was used to screen miRNAs, combined with gender, APOE4 genotype and miRNA data, stepwise regression was used to further screen independent variables and construct a multi-factor diagnostic model. Receiver operating characteristic (ROC) curves and calibration curves were used to verify the accuracy of the model in the training group, validation group, training group+validation group, and 1 309 total samples; A Nomogram was drawn for actual case prediction.Results:The area under the Curve of ROC of the multi-factorial diagnostic model in the training group, the validation group, the training+validation group and the total samples of 1 309 cases were 0.870, 0.831, 0.842 and 0.826, respectively, showing high predictive effectiveness. An AD case was used to show an example of applying the method and its predicted results (the total score of the patient was 521, and the probability of predicted NC was 0.022 8, indicating that the sample was AD, which was consistent with the actual diagnosis).Conclusions:The diagnostic model based on 11 serum miRNA, gender, and apolipoprotein E (ApoE4) genotypes can well predict AD and may provide the possibility for clinical prediction of AD.

[目的]探索轻度认知功能障碍(mild cognitive impairment,MCI)患者基于局部一致性(regional homogeneity,ReHo)的脑自发活动异常模式,并探究复方海蛇胶囊治疗MCI的疗效及潜在的脑功能药理机制.[方法]分别对入组的15例MCI患者及15例健康对照组受试者行静息态功能磁共振(resting-state functional magnetic resonance imaging,rs-fMRI)扫描,获取基线的影像数据,并对MCI患者进行智能以及日常生活能力量表评估,予单药复方海蛇胶囊口服治疗,0.9g/次,3次/d,于第6个月末再次对患者进行上述神经心理量表、不良反应的评估以及rs-fMRI扫描.分别比较健康对照组与MCI患者以及MCI患者治疗前后的神经心理评分和ReHo的差异.[结果]与健康对照组比较,基线时MCI患者右侧岛叶的ReHo值增高(P<0.01,体素≥29),左侧楔前叶以及右侧中央后回的ReHo值降低(P<0.01,体素≥29).基线时MCI患者的简易智力状态检查(mini-mental state examination,MMSE)量表评分与左侧楔前叶的标准化ReHo值呈正相关(P<0.05,r=0.705),蒙特利尔认知评估(Montreal cognitive assessment,MoCA)量表评分与左侧楔前叶(P<0.01,r=0.782)以及右侧中央后回(P<0.05,r=0.586)的标准化ReHo值呈正相关.治疗第6个月末,MCI患者的MMSE评分以及MoCA评分明显改善(P<0.01,P<0.01);MCI患者左侧楔前叶的ReHo值高于基线水平(P<0.01,体素≥29),变化差值与MoCA评分差值呈正相关(P<0.01,r=0.725),其余脑区未见明显改变.[结论]MCI患者在左侧楔前叶、右侧中央后回以及右侧岛叶存在ReHo改变.复方海蛇胶囊能够明显改善MCI患者的总体认知水平,并且与左侧楔前叶的ReHo存在相关性.

老年精神医学作为精神医学必不可少的一部分,已经逐渐从只关心年老体弱身心健康转变为老年脑科学研究的学科.由于疾病的发病机制复杂、治疗效果欠佳等问题,老年精神障碍的研究面临着巨大的挑战,急需更多创新有效的预防及治疗策略.现就常见的老年精神障碍在病理生理机制、治疗等方面的研究进展作一简要述评,以期引起更多同行关注老年精神障碍的研究.

目的 观察益气活血化瘀汤对宫腔镜下子宫肌瘤电切术后患者血清激素水平的影响及临床疗效.方法 接受宫腔镜子宫肌瘤电切术患者96例,随机将患者分为研究组和对照组,各48例.对照组术后给予常规治疗,研究组术后接受益气活血化瘀汤治疗;观察两组治疗12周后血清激素促黄体激素(LH)、促卵泡激素(FSH)、雌二醇(E2)及孕酮(P)水平、中医症状积分及临床疗效情况.结果 两组治疗前LH、FSH、E2和P水平差异均无统计学意义(均P＞0.05);治疗后,两组雌激素各项指标LH、FSH、E2和P水平均低于治疗前(均P＜0.05),且研究组各项激素水平均低于对照组(均P＜ 0.05).两组治疗前症状积分差异无统计学意义(P＞0.05);两组治疗后症状积分差异有统计学意义(P＜0.05),且研究组积分低于对照组(P＜0.05).对照组总有效率为77.1％,研究组为91.7％,两组总有效率差异有统计学意义(P＜0.05).结论 益气活血化瘀汤可降低宫腔镜下子宫肌瘤电切术后患者的血清激素水平,促进患者恢复.

目的 探讨盆炎方内服联合蒲地方灌肠治疗湿热瘀结型慢性盆腔炎症(Chronic Pelvic Inflammatory Disease,CPID)的效果,及对患者血清炎症因子与免疫水平的影响.方法 选择2017年9月-2018年2月于医院治疗的湿热瘀结型CPID患者100例为研究对象,随机分为试验组和对照组,各50例.对照组给予抗菌药物治疗,试验组除采用抗菌药物(头孢噻肟钠2.0 g/250 ml糖盐水溶液、0.5％甲硝唑100 ml注射静滴)外,使用盆炎方内服联合蒲地方灌肠治疗;采用酶联免疫吸附试验检测患者白细胞介素-2(IL-2)、IL-10和肿瘤坏死因子-α(TNF-α);采用速率散射比浊法检测免疫球蛋白G(IgG)、IgM、IgA的水平;采用单向免疫扩散法检测血清补体C3和C4水平;流式细胞技术检测CD3+、CD4+和CD8+的水平,并观察两组患者疗效情况.结果 治疗后,两组患者IgG、IgM和IgA均下降,补体C3和C4升高(P均＜0.05),且试验组IgG为(7.02±0.83)mg/ml低于对照组,补体C3和C4为(1.04±0.49)g/L和(0.72±0.01)g/L高于对照组(P＜0.001).治疗后,两组患者CD3+、CD4+和CD4+/CD8+均增高,CD8 1均下降(P＜0.05),且试验组CD3+、CD4+和CD4 +/CD8+分别为(62.53±2.70)％、(37.03±6.12)％和(1.52±0.13)高于对照组,CD8+为(23.20±2.72)％低于对照组(P＜0.05).治疗后,两组患者IL-2和IL-10均升高,而TNF-α下降(P＜0.001),且试验组IL-2和IL-10分别为(5.05±0.31)μg/L和(70.61±14.83)ng/L高于对照组,TNF-α为(1.11±0.32)μg/L低于对照组(P均＜0.001);试验组疗效优于对照组(P=0.008).结论 盆炎方内服联合蒲地方灌肠可提高抗菌药物治疗CPID的疗效,且可改善患者免疫水平、调节炎症细胞因子水平,具有一定的临床意义.

宫腔粘连(IUA)指的是在宫腔操作、术后感染等因素的影响之下所致的子宫内膜基底层受损,进而出现子宫肌壁间的互相粘连现象,也叫做阿谢曼综合征[1].近年来IUA的发病率呈上升趋势.通过宫腔镜下宫腔粘连分解术(TCRA)可以实现直接观测,进而将宫腔粘连分离或者切除,为目前诊断和治疗宫腔粘连的金标准[2].但是TCRA术后再粘连出现几率相对较高,达到了3.1％～23.5％,特别是中、重度的IUA患者术后复发率可以达到47.9％～62.5％[3].因而针对术后粘连复发进行有效防治也就成为了当前重点的研究课题.对此,笔者采用穴位电刺激联合周期疗法针对IUA术后患者进行治疗,取得了较好的临床效果.报道如下.

>轻度认知功能障碍(MCI)被认为是介于正常老龄化与痴呆之间的一个临床阶段。美国研究报道65岁以上人群MCI患病率为18.8%[1,2]。我国60岁以上老年人中MCI的发生率为3.2%～19.3%[3]。每年MCI向痴呆的转化率为10%～15%[4]。因此, 在MCI阶段早期识别及干预已成为目前专家共识, 并被广泛研究。静息态功能磁共振成像(rs-fMRI)是指被试在清醒并不进行任何系统性思考的休息

目的 探究盐酸美金刚联合复方海蛇胶囊治疗阿尔茨海默病(AD)的临床疗效及安全性.方法 纳入2015年10月至2016年6月就诊的AD患者共54例,随机分为美金刚组(对照组)和美金刚联合复方海蛇胶囊治疗组(观察组),观察6个月.采用简易智力状态检查量表(MMSE)、日常生活量表(ADL)、神经精神科问卷(NPI)评估患者认知状态、日常生活能力及精神行为症状(BPSD),采用不良反应量表(TESS)评估不良反应及耐受性,分别于基线和6个月末进行评估.通过Pearsonχ2检验、t检验及协方差分析对结果 进行统计学分析.结果6个月末,观察组患者在MMSE、ADL及NPI分数上均较基线水平有明显改善(P<0.05).对照组患者在MMSE及ADL分数上较基线水平有明显改善(P<0.05).观察组患者的MMSE评分明显高于对照组,ADL及NPI评分明显低于对照组(P<0.05).两组不良反应无统计学差异,均耐受良好.结论 美金刚联合复方海蛇胶囊治疗对AD患者的认知症状、日常生活能力及BPSD均有改善,疗效显著优于美金刚单药治疗.联用未进一步加重不良反应发生率,耐受性好.

目的:探讨健脾祛痰中药与穴位埋线共同用于肥胖型多囊卵巢综合征患者糖代谢病症的治疗效果.方法:选取肥胖型多囊卵巢综合征患者糖代谢病症114例作为研究对象,将其随机分成观察组57例(健脾祛痰联合药与穴位埋线治疗)和对照组57例(健脾祛痰中药治疗),对比两组的临床治疗效果.结果:经过治疗后,观察组的治疗有效率为94.74％,对照组患者的治疗有效率为87.72％,且观察组在BMI、腰围、空腹胰岛素、总胆固醇、甘油三酯、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、糖耐量异常、血脂异常、胰岛素抵抗方面均优于对照组,相比差异具有显著性(P＜0.05).结论:健脾祛痰类的中医药物和穴位埋线的治疗方法在对肥胖型多囊卵巢综合症患者进行临床治疗时,具有协同作用,两种方法联合使用能够降低患者的体质量指数、增强患者体内糖脂的分解代谢,并且治疗效果明显比单一的中药治疗的效果高,临床效果突出,具有实际推广应用价值.

Objective To evaluate the preventive effects of Haishe capsules on the conversion of amnestic mild cognitive impairment（a MCI）to Alzheimer’s disease（AD）.Methods Patients（n=120）with a MCI from our department were recruited and randomly divided into treatment group and control group（n=60 in each group）.The treatment group was given 0.9 gram of Haishe capsules

多囊卵巢综合征(PCOS)是一种常见的生殖功能障碍及糖脂代谢异常疾病,约50%的患者超重或肥胖[1-2].本研究拟从痰湿、瘀血论治PCOS,探讨滋肾调肝活血调周法联合二甲双胍片对PCOS患者脂代谢的影响.

目的:观察滋肾调肝活血调周法联合盐酸二甲双胍片治疗肝郁肾虚型多囊卵巢综合征(PCOS)的临床疗效.方法:纳入114例肝郁肾虚型PCOS患者,随机分为3组.中西药结合组39例给予滋肾调肝活血调周法联合盐酸二甲双胍片治疗;西药组38例单纯使用盐酸二甲双胍片;中药组37例单纯采用滋肾调肝活血调周法.3组均治疗3月.治疗结束后评估患者的治疗效果,观察治疗前后空腹胰岛素、餐后2h胰岛素水平及体质量指数(BMI)、腰臀比(WHR)、腰身比(WSR)、中心性肥胖率的变化.结果:中药组、西药组及中西药结合组的总有效率分别为67.57％、47.37％和94.87％.中西药结合组的总有效率均高于中药组和西药组(P＜0.05).中药组的总有效率高于西药组(P＜0.05).治疗后,3组空腹胰岛素及餐后2h胰岛素水平均较治疗前下降(P＜0.05).中西药结合组空腹胰岛素与餐后2h胰岛素水平均比中药组及西药组下降更明显(P＜0.05),西药组空腹胰岛素及餐后2h胰岛素水平均较中药组下降更明显(P＜0.05).治疗后,3组BMI、WHR、WSR及中心性肥胖率均较治疗前下降(P＜0.05);中西药结合组的上述4项人体测量学指标均较西药组及中药组下降更明显(P＜0.05);中药组的4项人体测量学指标与西药组比较,差异均无统计学意义(P＞0.05).结论:滋肾调肝活血调周法联合盐酸二甲双胍片可有效改善肝郁肾虚型PCOS患者的临床症状,降低胰岛素水平.

Objective To investigate the needs for diagnosis and treatment techniques for depression and dementia in community doctors in Zhejiang province. Methods“Depression and senile dementia diagnosis and treatment questionnaire” (including 20 techniques) was designed. Community doctors were surveyed in ten cities. A total of 612 questionnaires were issued, and 590 were reclaimed, 533 of which were valid questionnaires. For different levels of hospitals, hospitals of different properties, different majors, different professions, different working experience of doctors on the technical demand percentage were compared and analyzed. Count data were compared by chi square test. Results Different levels of hospitals, hospitals of different properties, different majors, different professions, different working experience of doctors on the technical demand percentage were signiifcantly higher than the percentage of non-demand. The percentage of doctors in tertiary hospitals on the technology demand for MECT was significantly higher than secondary hospitals, street hospitals and community hospitals (χ2=11.42, 6.92, 8.75,allP< 0.01). Except for the modified electric shock technology and the senile dementia screening technology, there were no signiifcant differences in the needs of different professional physicians in the treatment of depression and senile dementia. The percentage of psychiatrists on the technology demand of MECT was higher than that of other professional physicians. The percentage of surgeons on the technology demand for Alzheimer's screening was lower than those of other professional physicians (χ2=8.90,P<0.01). The percentage of doctors' seniority in 1~3 years on the technology demand for psychiatric interview was lower than the percentage of other seniority groups (χ2=6.09, P<0.05). ConclusionPrimary medical staff in Zhejiang province have a strong demand for the technology of diagnosis and treatment in depression and senile dementia. After the questionnaire survey, the speciifc needs of the medical staff can be understood. It will be more targeted in the next step of the training and improve the training effect.

目的 探讨青春期多囊卵巢综合征患者情志证素的分布特点及与性激素、血糖血脂指标的相关性,为中医规范化治疗青春期多囊卵巢综合征提供新思路.方法 收集2014年11月~2016年6月至宁波市中医院妇科门诊就诊的165例青春期多囊卵巢综合征患者的一般资料、证素相关四诊信息与血液生化指标,采用"证素辨证"及积分的方法 进行计算,观察肝、气滞证素与西医客观指标之间的相关性.结果 肝证素积分、气滞证素积分与睾酮(T)、泌乳素(PRL)、空腹胰岛素相关,差异有统计学意义(P<0.05或P<0.01).结论 中医情志相关的肝郁气滞是青春期多囊卵巢综合征的重要病机.

Objective:To observe the improvement effect of tonifying kidney and promoting blood circulation to regulate menstrual cycle method on ovarian reserve function of patients with repeated failure of fertilization-embryo transplant in vitro and explore the mechanism. Methods:60 Cases with repeated failure of fertilization-embryo transplant in vitro were divided into two groups randomly, observe group was given Chinese and western medicine, control group was given western medicine, each group contained 30 cases, the changes of clinical symptoms an signs were observed before and after treatment, dosage of gonadotropin was recorded, serum estrogen, FSH, inhibin-B and anti Mullerian hormone were determined by ELISA method, number of oocytes, good quality rate of follicle, fertization rate, good quality rate of embryo and pregnancy rate were observed. Results:The clinical symptoms and signs of patient with repeated failure of fertilization-embryo transplant in vitro were significantly improved, there was obvious difference between the two groups, the dosage of FSH in the observed group was less than that of control group, serum E2, inhibin-B and anti Mullerian hormone levels of observe group were significant higher than those in control group, serum FSH level was obviously lower than that of control, the number of oocytes, good quality rate of follicle, fertization rate, good quality rate of embryo and pregnancy rate in observed group were better than those in control, the differences were significantly. Conclusion:Tonifying kidney and promoting blood circulation to regulate menstrual cycle method can improve the ovarian reserve function of patients with repeated failure of fertilization-embryo transplant in vitro, its mechanism was related to raise anti Mullerian hormone and inhibin-B levels, regulate the function of hypothalamic-pituitary-gonadal axis.

慢性盆腔炎是妇科常见病多发病,近年来发病率呈上升趋势.我院采用自拟湿热蕴积方配伍克林霉素及普鲁卡因保留灌肠治疗本病,取得满意效果,现报道如下. 1 临床资料

慢性盆腔炎是妇科常见病、多发病,常反复发作,缠绵难愈,易引起慢性盆腔痛,不孕不育等,严重影响妇女身心健康.我院采用中药配伍克林霉素及普鲁卡因保留灌肠治疗该病70例,疗效满意,现报道如下.