目的 观察膈下逐瘀汤加减方辅助治疗中、重度气滞血瘀型肝癌疼痛患者的临床疗效和安全性.方法 56例患者随机分为对照组(28例)和试验组(28例),对照组按WHO癌痛治疗“三阶梯原则”予以药物止痛治疗,试验组在对照组基础上加用膈下逐瘀汤加减方治疗.结果 对照组和试验组疼痛缓解的总有效率分别为60.7％、85.7％,两组比较差异有统计学意义(P＜0.05).两组治疗后NRS评分较前均有显著下降,差异有统计学意义(P＜0.05),治疗后试验组NRS评分低于对照组,两者差异有统计学意义(P＜0.05).中医证候疗效比较,治疗后试验组中医证候评分明显优于对照组,差异有统计学意义(P＜0.05).结论 膈下逐瘀汤加减方辅助治疗方案可以明显缓解中重度气滞血瘀型肝癌患者癌性疼痛,改善中医症状,且安全可靠.

目的 观察杞荷祛脂方配合肝病治疗仪治疗非酒精性脂肪性肝炎(NASH)的临床疗效.方法 将90例NASH患者随机分成两组(观察组及对照组),观察组(45例)给予口服杞荷祛脂方配合肝病治疗仪治疗,对照组(45例)给予单纯口服多烯磷脂酰胆碱胶囊治疗,观察两组治疗前后肝功能、血脂以及肝脏超声影像变化.结果 治疗12周后,观察组总有效率为91.1％,对照组总有效率为77.8％,观察组疗效优于对照组(P＜0.05);观察组肝功能、血脂以及肝脏B超检查结果较治疗前均有显著改善,并优于对照组(P＜0.05).结论 杞荷祛脂方配合肝病治疗仪治疗NASH疗效优于口服多烯磷脂酰胆碱胶囊,值得临床应用.

Objective To evaluate the effect of nursing clinical pathway with integrated traditional Chinese medicine and western medi-cine on sleep quality in patients with liver cirrhosis with ascites.Methods Totally,208 patients with liver cirrhosis with ascites were divided into study group (n=110) and control group (n=98).The control group receive clinical care pathways,the study group receive nursing clini-cal pathway with integrated traditional Chinese medicine and western medicine,the Pittsburgh Sleep Quality Index( PSQI) were observed in 2 groups.Results The score of PSQI in study group were lower after intervention,and also lower than control group(P<0.01 or P<0.05). Conclusion Nursing clinical pathway with integrated traditional Chinese medicine and western medicine can effectively improve the quality of sleep in patients with liver cirrhosis with ascites.

To study the status of Distribution and Exploitation of the Traditiona-l Chinese Medieinal resources in Huangshi City of Hubei Province by means of field survey,specimen collection,species identification,data gathering,mark-et research etc.We find out There were 611 species of wild medicinal plant in common use belonging to 145 families in Huangshi City,of which 6 family,9 species of fungi,16 family,31 ferns,7 family,8 species of gymnosperms,1～16 family,563 species of angiosperms,and 24 kinds of medicinal plants of la-rge development value.So the area of eastern Hubei has fairly rich resources of medicinal plants which has good development value.We also prop-osed some suggestions:strengthenly protect the resources of medical plant,vigorously developing authentic medicinal materials and so on.

Objective:To study the changes of serum ferritin and clinical significance in patients with nonalcoholic fatty liver disease (NAFLD).Methods:The serum ferritin (SF) and serum biochemical markers were examined in 96 NAFLD patients and 100 healthy subjects.To analyze and evaluate the changes of SF in patients with NAFLD and the correlation with other indexes.Results:NAFLD patients with body mass index (BMI),waist circumference,ALT,γ-GT,TC,TG were higher than those of healthy controls,the difference was statistically significant (P ＜ 0.05).The serum ferritin (SF) in patients with NAFLD was higher than that in healthy subjects,and the difference was statistically significant (P ＜ 0.05).Correlation analysis showed that SF was positively correlated with ALT,AST and γ-GT (P ＜ 0.05),and no correlation with TG and TC (P ＜ 0.05).Conclusion:The level of serum SF was correlated with the level of liver function in patients with NAFLD,and the detection of associated indexes was helpful to judge the progress of liver injury in patients with NAFLD.

目的 观察β-榄香烯对人肝星状细胞系LX-2增殖及细胞周期的影响.方法 将对数生长的LX-2细胞培养24h,分别以质量浓度1.25mg/L,2.5 mg/L,5 mg/L,10 mg/L,20 mg/L,40 mg/L,80 mg/L的β-榄香烯作用LX-2细胞24h,48h,72h,并设立空白对照组;以四甲基偶氮唑蓝法(MTT)检测细胞增殖,流式细胞仪检测细胞周期.结果 作用时间为24h时,β-榄香烯浓度达5mg/L及以上才能显著抑制LX-2增殖(P＜0.05);作用时间为48h、72h时,不同浓度的β-榄香烯均能显著抑制LX-2增殖(P＜0.05),且随着浓度升高,抑制率显著升高(P＜0.05);24,40mg/L β-榄香烯处理LX-2细胞48h后,G0/G1期细胞增多,S期、G2/M细胞减少(P＜0.05).结论 β-榄香烯可抑制人肝星状细胞系LX-2细胞增殖,阻滞LX-2细胞周期.

建立分级诊疗制度、实行基层首诊和加强基层医疗卫生机构服务能力建设已经成为新一轮医药卫生体制改革的重要内容,是合理配置医疗资源、实现基本医疗卫生服务均等化的重要举措.文章主要阐述地市级中医院在分级诊疗中面临的一些困境,及如何在分级诊疗工作过程中,结合当地、当院的实际情况,制定适合自己的发展之道,不断提升医院核心竞争力,勇于迎接挑战,在困境中不断前行.

Objective:To analyze the differential expression protein of human hepatic carcinoma cell line SMMC-7721 under the Gexia Zhuyu decoction( GXZY) pharmacological serum, in order to find the anti-tumor target of GXZY.Methods:Subcultured human hepatic car-cinoma cell line SMMC-7721 were randomly divided into GXZY pharmacological serum groups and blank drug serum group, using two-dimen-sional gel electrophoresis, MALDI-TOF-MS to analyze the differential expression protein.Re sults:High expression of 33 protein spots was found in each of the groups, 6 proteins were identified by mass spectrometry analysis.Expression of 5 protein spots in GXZY pharmacological serum group decreased(AHCY,PGAM1,STMN1, HSP90AB1, VAT1) and 1 increased (TPM4).Conclusion:There are differential expres-sion proteins of human hepatic carcinoma cell line SMMC-7721 in GXZY pharmacological serum, these differential expression proteins may be the therapeutic targets of GXZY.

目的 观察替比夫定联合强肝健脾方治疗肝郁脾虚型慢性乙型肝炎的临床疗效.方法 将186例患者随机分为两组.治疗组96例给予强肝健脾方联合替比夫定治疗,对照组90例单纯用替比夫定治疗.治疗第4周、12周、24周、48周后分别观察两组患者谷丙转氨酶(ALT)复常率、HBV-DNA转阴率、HBeAg转阴率.结果 治疗组治疗第4周ALT复常率优于对照组(P＜0.05),但在治疗第12周、24周、48周,两组ALT复常率比较差异均无统计学意义(P＞0.05);两组在治疗第4周、12周的HBV-DNA阴转率和第12周、24周、48周HBeAg转阴率比较,差异均有统计学意义(P＜0.05).结论 替比夫定联合强肝健脾方能明显改善肝功能,并有一定抗乙型肝炎病毒的作用,疗效肯定.

目的 观察蕲艾提取液对肝纤维化大鼠肝组织中TGF-β1、CyclinD1和Bcl-2 mRNA和蛋白表达的影响,探讨其对肝纤维化作用及相关机制.方法 Wister大鼠72只被随机分为正常对照组、肝纤维化模型组、小、中、大剂量蕲艾提取液处理组和丹参对照组,采用猪血清腹腔内注射法构建肝纤维化大鼠模型;采用荧光定量PCR和Western blot检测大鼠肝脏组织TGF-β1、CyclinD1和Bcl-2 mRNA和蛋白表达水平.结果 各蕲艾提取液处理组与肝纤维化模型组相比,肝组织中TGF-β1、CyclinD1和Bcl-2 mRNA和蛋白水平均明显降低,差异有统计学意义(P＜0.05或P＜0.01).结论 蕲艾提取液可显著抑制肝组织中TGF-β1、Cyclin D1 mRNA及其蛋白表达,抑制细胞增殖与活化;同时下调抗凋亡基因Bcl-2的表达,促进肝星状细胞的凋亡,降低细胞外基质合成,从而达到抗纤维化的作用.

As a novel research tool,metabolomics technology can reveal the differences in metabolic profiles during the development and progression of hepatocellular carcinoma(HCC),so it has been widely applied for research on HCC biomarkers.The significance of metabolomics in the diagnosis of HCC is briefly described,and the metabolomics research aiming at the discovery of HCC biomarkers,including animal experiments and clinical studies of metabolites in the serum,urine,and liver tissue,is reviewed.It is pointed out that analyzing and monitoring metabolites in the development and progression of HCC is of great significance for individualized treatment.

肝纤维化是由于细胞外基质(ECM)的合成和降解失衡,ECM过量沉积而形成的,是慢性肝病的共同病理学基础,为发展成肝硬化的必经病理阶段.目前,肝星状细胞(HSC)被公认为是肝纤维化时ECM过度沉积的关键细胞[1],HSC的活化和增殖又是肝纤维化发生进展的中心环节,而细胞增殖可以通过细胞周期测定来实现.我们通过体外实验观察蕲艾提取液药物血清对于HSC的影响,研究其抗纤维化的作用机制.

目的 观察蕲艾提取液对肝纤维化大鼠肝组织中Smad3、Smad7 mRNA和蛋白表达的影响,探讨其对肝纤维化作用及相关机制.方法 Wister大鼠72只被随机分为正常对照组、肝纤维化模型组、小、中、大剂量蕲艾提取液处理组和丹参对照组,采用猪血清腹腔内注射法构建肝纤维化大鼠模型；病理切片HE染色评价各组大鼠肝组织纤维化程度；采用荧光定量PCR和Western blot检测大鼠肝脏组织Smad3、Smad7 mRNA和蛋白表达水平.结果 各蕲艾提取液处理组与肝纤维化模型组相比,组织病理学上肝纤维化程度显著减轻；肝组织中Smad3 mRNA和蛋白水平均明显降低,Smad7 mRNA和蛋白水平均明显升高,差异有统计学意义.结论 蕲艾提取液可以降低肝纤维化大鼠肝组织Smad3的表达,上调Smad7的表达,从而发挥抗肝纤维化作用.

10.3969/j.issn.1674-7860.2013.08.049

[Objective]To investigate the effect of Artemisia argyi extract solution on the expression of Cyclin D1 in rat with hepatic fibrosis.[Methods]Seventy-two wister rats were randomly divided into normal control group,liver fibrosis model group,Artemisia Argyi extracting solu tion low,middle and high-dose group,and the Salvia group.Rat liver fibrotic models were established by intraperitoneal injection with pig serum.The expression of Cyclin D1 mRNA and protein was detected by RT-PCR and western blot respectively.[Results]Artemisia argyi extract solution group could down-regulate the expression of Cyclin D1 mRNA and protein compared with liver fibrosis model group(P0.05,P0.01).[Conclusion]Artemisia argyi extract solution get down the expression of Cyclin D1,playing on cell cycle regulation,which maybe one of the mechanisms of anti-liver fibrosis.

目的 研究蕲艾提取液对免疫性肝纤维化大鼠肝组织Bcl-2表达的影响.方法 72只Wister大鼠被随机分为正常对照组、肝纤维化模型组、蕲艾提取液低、中、高剂量组和丹参组.猪血清腹腔内注射法构建肝纤维化大鼠模型.采用荧光定量PCR和Western blot检测大鼠肝脏组织Bcl-2蛋白和,mRNA表达水平.结果 与肝纤维化模型组比较,蕲艾提取液组可下调Bcl-2 mRNA及蛋白表达(P<0.05,P<0.01).结论 蕲艾提取液可下调Bcl-2的表达,促进细胞凋亡,这可能是蕲艾提取液药物血清抗肝纤维化作用机制之一.

Objective:To investigate the effect of Artemisia Argyi extract solution drug serum on expression of cyclin D1 in rat hepatic stellate cells(HSC).Methods:HSC-T6 was incubated with Artemisia Argyi extract solution drug serum(5%,10%,20%) for 24 hours,the expression of cyclin D1 mRNA and protein was detected by RT-PCR and Western blot.Results:Different concentrations of Artemisia Argyi extract solution drug serum(5%,10%,20%) could inhibit the cyclin D1 mRNA and protein expression significantly(P0.01) compared with blank control group and the serum control group.Conclusion:Artemisia Argyi extract solution drug serum is through inhibiting HSC-T6 cyclin D1 mRNA and protein expression,playing on cell cycle regulation,which may be one of the mechanisms of anti-liver fibrosis.

笔者通过自拟杞荷祛脂汤治疗非酒精性脂肪性肝炎60例,取得良好疗效,并与水飞蓟宾胶囊治疗的60例作临床对照,现报道如下. 1 资料与方法 1.1 一般资料 120例非酒精性脂肪性肝炎患者为2009年3月-2010年3月本院门诊和住院患者,随机分为两组,治疗组6O例,男4l例,女19例;年龄26~70岁;病程3个月~4年.对照组6O例,男38例,女22例;年龄28~65岁;病程5个月~3年.两组患者在性别、年龄、病程及病情程度等方面经统计学处理,差异无显著性意义(P＞0.05),具有可比性.

Objective:To study the effects of Artemisia Argyi extracting solution on expression of transforming growth factor-β1(TGF-β1) in immunological hepatic fibrosis rats.Methods:Seventy-two experimental Wister rats were randomly divided into normal control group,hepatic fibrosis model group,Artemisia Argyi extracting solution low,middle and high-dose group,and Danshen control group.Rat liver fibrotic models were established by intraperitoneal injection with pig serum,and the degrees of liver fibrosis of each group were identified by hematoxylin and eosin(HE).Besides,the TGF-β1 levels of rats’ serum were detected by ELISA,and the mRNA and protein levels of TGF-β1 in rats’ liver were detected by Real-time PCR and Western blot,respectively.Results:Compared with the hepatic fibrosis model group,the degree of hepatic fibrosis in rats of Artemisia Argyi extracting solution therapeutic groups reduced significantly,and the contains of TGF-β1 protein in rats’ serum,TGF-β1 mRNA and protein expression levels in liver tissues decreased significantly at the same time.Conlusion:Artemisia Argyi extracting solution can protect rats liver suffered with immunological hepatic fibrosis by the way of reducing TGF-β1 synthesis and secretion.

湖北中医学院附属医院肝病研究所主任医师、博士生导师、国家级名老中医张赤志教授,从事中医肝病临床、教学和科研工作40余年,学验俱丰,对阴黄的治疗有着独到见解,余随师临证,受益匪浅,现将张师经验介绍如下.