目的:探讨应用中药治疗痰湿质糖尿病患者的配方规律.方法:检索2000年1月至2020年9月在维普数据库、万方数据知识服务平台、中国知网(CNKI)数据库中以痰湿质为特征的糖尿病患者的中药治疗文献,提取文献中使用的中药处方,对高频使用中药进行频次分析、关联分析及聚类分析.结果:本研究共采用文献168篇,其中中药处方169首,其中使用次数在10次以上的中药35味,使用次数最多的中药为茯苓(116次),最常用的药物(使用次数降序)依次为茯苓、半夏、陈皮、白术、苍术、黄连、黄芪、葛根,关联分析显示,茯苓→厚朴、茯苓→甘草+陈皮、茯苓→甘草+陈皮+半夏的组合较为常见,通过系统聚类算法得到得到核心中药处方组合7个.结论:治疗痰湿质糖尿病患者,应用健脾利湿化痰的中药为主,根据患者的常见合并症状,配以清热、化瘀及养阴功效的中药较为常见.

目的 探讨中药健脾益气方联合穴位贴敷防治乳腺癌化疗后胃肠道反应的临床疗效.方法 将广东省深圳市第二人民医院2016年12月—2018年10月收治的98例乳腺癌患者按照随机数字表法分为2组,每组49例,2组患者均接受乳腺癌改良根治术,术后应用TAC方案进行新辅助化疗.对照组应用昂丹司琼口服和中药穴位贴敷防治化疗后胃肠道反应,观察组在对照组用药基础上给予中药健脾益气方口服.比较2组化疗日、化疗后24 h、48 h、72 h恶心、呕吐分级,并比较2组化疗前后血清胃动素、胃泌素水平.结果 化疗日、化疗后24h、48h、72h观察组恶心、呕吐程度分级均明显低于对照组(P均<0.05);化疗后2组血清胃泌素、胃动素水平较化疗前明显降低(P均<0.05),但观察组上述指标均明显高于对照组(P均<0.05).结论 健脾益气方联合穴位贴敷可缓解乳腺癌化疗后胃肠道反应,其机制可能与改善胃肠激素紊乱有关.

目的:观察中药扶正消水散外敷治疗恶性肿瘤术后放化疗后肢体水肿的临床疗效.方法:选取深圳市第二人民医院2017年1月至2019年10月收治的240例乳腺恶性肿瘤术后放化疗后出现肢体水肿的患者,随机分为三组,观察组80例子扶正消水散外敷,口服对照组80例予口服呋塞米治疗,理疗对照组80例予气压物理治疗.疗程均为1周,分别观察、比较并记录三组疗效.结果:观察组患者的总有效率为87.5％高于口服对照组的57.5％以及理疗对照组的67.5％,差异具有统计学意义(P＜ 0.05);三组患者治疗前后纤维蛋白原(FIB)、白蛋白(ALB)水平比较,差异具有统计学意义(P＜0.05).结论:扶正消水散外敷治疗乳腺恶性肿瘤术后肢体淋巴水肿有较好疗效,且副作用少.

目的:观察中药通络壮骨散外敷治疗乳腺癌内分泌治疗后骨质疏松的疗效.方法:220例乳腺癌内分泌治疗后骨质疏松患者,随机分为治疗组和对照组,每组110例,对照组口服碳酸钙D3片,治疗组在对照组基础上外敷通络壮骨散.疗程均为25周,对比治疗前后腰椎骨密度的变化.结果:两组骨密度均增加(P<0.05),治疗组骨密度高于对照组(P<0.05);并两组的I型原骨胶原蛋白N-端肽(s-PINP)均降低(P<0.05),治疗组s-PINP低于对照组(P<0.05);两组碱性磷酸酶(ALP)降低、骨钙素(BGP)增加(P<0.05),治疗组ALP低于对照组,BGP高于对照组(P<0.05).结论:钙剂联合中药通络壮骨散外敷治疗乳腺癌内分泌治疗后骨质疏松效果更好.

黑斑息肉综合征(Peutz-Jeghers syndrome,PJS)又名黑色素斑一肠息肉综合征,是一种以口唇颊黏膜和四肢末端等部位黑色素斑点沉着、胃肠道多发息肉为特征的常染色体显性遗传疾病,发病率为1/20万,其中40％ ～ 50％有家族史,主要由染色体19p13.3上的LKB1/STK11(丝氨酸/苏氨酸激酶)基因突变导致,BRG1、STRAD-a、M025-a也与本病的发生及发展有关[1].当息肉较大时易并发肠梗阻、肠套叠等并发症,加之PJS患者肿瘤的发病风险较健康人高15倍,不仅胃肠道恶性肿瘤的发病风险增加,而且胃肠道以外肿瘤的发病风险亦显著提高[2].由于PJS发病率极低,但恶变程度高,所以临床上应引起重视.现将1例PJS患者治疗过程报告如下.

Objective:To evaluate the relationship and consistency between the levels of neuron specific enolase (NSE),pro-gastrin releasing peptide (PoGRP)and the changes (remission or progression)of conditions in small cell lung cancer patients by observing the variations of NSE and ProGRP levels.Methods:Clinical data including serum NSE and ProGRP levels of forty-seven SCLC patients that were treated in China-Japan Friendship Hospital were analyzed retrospectively.Results:At the beginning of diagnosis,serum NSE,ProGRP in patients with extensive diseases were significantly higher than those with limited diseases (P＜0.05).The levels of NSE and ProGRP were significantly decreased when the disease were undercontrolled(P＜0.05).The levels of ProGRP were significantly increased when the disease progressed (P＜0.05).When the disease were undercontrolled,the consistency rates of NSE and ProGRP were both 100％ and the median decline rates were 70.59％ and 85.11％,respectively.When the disease progressed,the consistency rates of NSE and ProGRP were both 86％ and the median rise rates were 128.57％ and 86.12％,respectively.Conclusion:NSE and ProGRP can be used as the markers to predict the clinical stage;the levels of ProGRP and NSE can be used as condition monitoring indicators and ProGRP maybe superior to NSE.We should strengthen the detection of NSE and ProGRP in patients of SCLC during their diagnosis and treatment.

Lung adenocarcinoma is the most common pathological pattern of lung cancer. During the past decades, a number of targeted agents have been explored to treat advanced lung adenocarcinoma. In the present clinical practice, antagonists of the epidermal growth factor receptor (EGFR) and vascular endothelial growth factor (VEGF)-directed therapies are widely used. In the former category, the agent erlotinib (tyrosine kinase inhibitor) has shown obvious advantages over cytotoxic therapy. Anti-VEGF therapy bevacizumab used for lung adenocarcinoma was recommended in NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) as first-line therapy. Similarly, apatinib is speculated to response by selectively inhibiting the vascular endothelial growth factor receptor-2. The patient with unknown EGFR status benefited 5-month progressive free survival (PFS) from erlotinib, and then another 5.1-month PFS with combined treatment of apatinib, which suggested a new option for lung adenocarcinoma. However, when dabigatran was used to cancer-related venous thromboembolism during apatinib therapy, extensive subcutaneous bleeding occurred, warning us against the risks of bleeding. Besides, hypertension and anorexia were observed, causing dosage adjustment.

Objective:To evaluate the efficacy and safety of aprepitant in the prevention of nausea and vomiting induced by moderately and highly emetogenic chemotherapy.Methods:Medline,Cochrane Library,Pubmed,CNKI,CBM,Wanfang and VIP were searched (up to October 2016).Eligible randomized controlled trials evaluating the efficacy of aprepitant versus conventional antiemetics in the prevention of chemotherapy-related nausea and vomiting (CINV) were included.The outcome indicators were complete response (CR) during acute or delayed vomiting,control rate of nausea and adverse reactions.Results:Eighteen high quality RCTs were included.Compared with the control group,the acute CR was significantly improved in the aprepitant group (84.5％ vs 77.4％,OR =1.60,P ＜ 0.01) and the subgroup analysis showed that the cisplatin regimen was superior to the carboplatin and AC regimen.However,the control rate of acute nausea was no significantly different between the two groups (88.6％ vs 85.4％,OR =1.41,P =0.02).Aprepitant could significantly improve the complete response of delayed vomiting.Compared with 5-HT3RA,aprepitant could improve vomiting by 7.8％ (62.9％ vs 55.1％,OR =1.39,P ＜0.01).Compared with placebo,aprepitant could improve vomiting by 14％ (67.4％ vs 53.4％,OR =1.85,P ＜ 0.01).When aprepitant was combined with dexamethasone,the delayed CR was improved by 17.9％ (73.2％ vs 55.3％,OR =2.22,P ＜0.01).The control rate of delayed nausea was improved by 9.3％ when aprepitant was combined with dexamethasone (74.4％ vs 65.1％,OR =1.55,P =0.01).As for the adverse reactions,the incidence of fatigue was higher for the aprepitant regimen (P =0.01),while the incidence of constipation was lower (P =0.03).The incidences of headache,diarrhea and anorexia were not significantly different between the two groups.Conclusion:Aprepitant is well tolerated and can improve the control of delayed CINV and acute vomiting,especially in patients receiving cisplatin chemotherapy,but has slight effect on acute nausea.Further study is warranted on the efficacy of aprepitant in the prevention of CINV caused by different chemotherapy regimens.

Objective To observe the curative effect of Zhiyang Pingfu Lotion (ZPL) for its ex- ternal application in treatment of epidermal growth factor receptor inhibitors (EGFRIs)-related acneiform rash, cutaneous pruritus , xerosis cutis , and nail changes , as well as to evaluate its safety and patients' satisfaction. Methods Recruited were 201 patients with confirmed pathological diagnosis, who had acne- iform rash after using EGFRIs. They were assigned to the treatment group (131 cases) and the control group (70 cases) by random digit table. Patients in the treatment group were externally applied with self- formulated ZPL based on principles of Western medical standards, while those in the control group were externally applied with blank drugs plus conventional Western medicine standard. The therapeutic course for all was 14 days. Changes in rash degree, cutaneous pruritus, xerosis cutis, and nails were observed in both groups before and after treatment. Blood routines as well as liver and kidney function tests were performed in both groups before and after treatment. Follow-up visit was also conducted during progression-free survival (PFS). Results A total of 185 patients finished this clinical trial. Ten dropped out in the treatment group and 6 in the control group. The effective rates of rash degree, cutaneous pruritus, xerosis cutis, and nail changes were 90.1 % (109/121 ), 57.9% (70/121 ), 57. 9% (70/121 ), and 16. 5% (20/121) in the treatment group, respectively. They were 14. 1% (9/64), 6. 3% (4/64), 1. 6% (1164), and 0 (0/64) in the control group, respectively. Significant difference existed in all these indices between the two groups (X² = 105. 1022, 51. 3312, 59. 1777; P <0. 05). No serious drug-related adverse events occurred during clinical observation, with relatively better safety. The satisfaction was 95. 40% (125/131) in the treatment group and 57. 1 % (40/70) in the control group. No statistical difference in PFS was observed between the two groups (X² = 2. 006, P > 0. 05). Conclusions ZPL had significantly curative effect in treatment of EGFRIs-related skin adverse reactions, with no obvious adverse reactions. Howev- er, more randomized control trials are needed to verify these findings.

恶性肿瘤已成为常见病、多发病,其发病率逐年上升,已成为严重威胁人类生命健康的重要原因,除少数患者可进行早期根治性手术外,大部分患者仍需要包括放疗、化疗、分子生物治疗、靶向治疗、中医药等综合治疗.中西医结合肿瘤学科目前发展迅速,对中西医结合肿瘤学人才的需求也越来越多.研究生教育作为高等教育的重要组成部分,是培养高素质专业人才的主要方式,也是成为合格的中西医结合肿瘤学人才的关键阶段.作为中西医结合肿瘤学研究生,思考如何提高自身的专业素养,提升肿瘤临床诊疗水平,实现肿瘤治疗的规范化、综合化、个体化,以满足社会发展的需求,具有重要意义.

The effective long-term control method for malignant pericardial effusion is still lacking in the clinical practice.Studies have indicated that vascular endothelial growth factor (VEGF) plays a key role in the formation of serous cavity effusion,the bevacizumab (Avastin) as specific antibody of VEGF,can effectively prevent the formation of fluid.However,the intrapericardial infusion of bevacizumab has not been widely used.Therefore,this paper reports 1 cases of lung cancer patient complicated with pericardial effusion,who was treated by the intrapericardial injection of bevacizumab,for reference.

Objective Erlotinib (Trade Name:Tarceva) is a new targeted drug for the treatment of non-small cell lung cancer (NSCLC) that has a wide clinical application in recent years , but commonly carries many side effects , among which the most common and unbearable one is rash .The aim of this study is to observe the changes of epidermis , pathology, immunohistochemistry and other aspects before and after the application of Tarceva in mice and try to copy the rash animal models caused by Tarceva and thus to provide models for the clinical topical medications of rash .Methods 20BALB/c female mice were randomly divided into four groups .The experimental group (Ⅱ、Ⅲ、Ⅳ group) was given 100 mg/kg dosage with the concentration of 10 g/L erlotinib solution by gavage, and the control group (Ⅰ group)with an equal volume of deionized water by gavage once daily .The hairs from the head,neck and back of each mouse were removed 24 hours prior to the administration ,and at the end of the experiment , clipping the skin in the neck , back and waist ,then observed differences between the experimental group and the control group in mice skin , biopsy, immunohistochemistry and the like.Results (1)There were statistically significance (P <0.01 or P <0.05) in the four groups of mice in fiveaspects as hair regrowth days , days of the complete regrowth of hair , desquamation time , the time of appearance of rash and the number of pore expansion;(2) Ki67:There were no statistically significant differences among the four groups ( P >0.05).Conclusions (1)This experiment confirms many researchers ' point of view that "the rash induced by EGFRIs is an inflammatory response"(2)A mouse model of rash induced by FGFRIs is successfully established ,and this is a reliable, practical and reproducible model which applies to a large number of establishment of "EGFRIs drug-induced rash in animal models",and can be popularized for clinical ,experimental and institutional uses .

目的:探讨吉非替尼诱发的严重间质性肺病(interstitial lung disease,ILD)的发病机制、诊断与治疗.方法:对1例吉非替尼导致的ILD进行报道,并复习相关文献.结果:吉非替尼导致的ILD发生率低、病死率高.其危险因素包括男性、吸烟、既往肺间质纤维化等,主要临床表现为咳嗽、呼吸困难以及低氧血症,治疗方法以激素为主,辅以抗感染等支持治疗.结论:监测正在服用吉非替尼的患者的肺部症状和体征,及时诊断、尽早治疗,对于吉非替尼所致ILD的预后尤为重要.

目的:了解新药白蛋白结合型紫杉醇罕见的不良反应,提高用药的安全性.方法:报告1例应用白蛋白结合型紫杉醇后,出现致死性肺间质纤维化的晚期肺鳞癌患者的临床资料,进行分析讨论.结果:该例患者在应用白蛋白结合型紫杉醇10d后出现发热、恶心呕吐、伴全身疼痛、乏力,23 d后出现咳嗽、咳痰、憋气,28 d出现严重的呼吸困难、窒息死亡.结论:白蛋白结合型紫杉醇可致肺间质纤维化,既往有肺间质病基础的患者应慎用,联合放疗时也可能加重放射性肺炎.

Objective To make a comparative study on pathological pattern,age and gender of inpatients with primary lung cancer in China - Japan Friendship Hospital from 2005 to 2014,in order to investigate the epidemiologic features of inpatients with lung cancer in the hospital in the past 10 years. Methods We made an investigation on the clinical data of patients with primary lung cancer who were firstly admitted into China - Japan Friendship Hospital from 2005 to 2014. Statistical analysis was made on the pathological types of lung cancer,onset age and gender distribution. Results A total of 4 114 patients with primary lung cancer who were firstly admitted into the hospital from 2005 to 2014 were recruited,with pathological diagnosis for 3 183 and clinical diagnosis for 931 patients. The patients with lung adenocarcinoma accounted for 52. 25% (1 663 / 3 183) with the highest proportion,and the number of males was 1. 98(2 734 / 1 380)times that of females. The peak onset age range was 56 - 75,and the patients of this age range accounted for 60. 73% (2 499 / 4 114). The pathological type distribution was not significantly different among different years( χ2 = 27. 277,P = 0. 449),and the age distribution was not significantly different among different years( Z = 0. 573,P = 0. 999). Age distribution was not significantly different between males and females(χ2 = 0. 152,P = 0. 879),and gender distribution was not significantly different among different years(χ2 = 6. 446,P= 0. 695). Rank correlation analysis showed that distribution of 56 - 65 age group was positively correlated with year( rs =0. 806,P = 0. 005). Conclusion The number of primary lung cancer patients admitted by China - Japan Friendship Hospital in the past 10 years is increasing,and prevalence is highest in adenocarcinoma,second highest in squamous carcinoma and third highest in small cell lung cancer. The peak onset age range is 56 - 75. Males are higher than females in the prevalence of squamous carcinoma.

目的 观察应用表皮生长因子受体抑制剂药物的肺腺癌患者出现皮肤不良反应的中医证候特点.方法 采用前瞻性的研究方法,选取使用表皮生长因子受体抑制剂治疗并产生皮肤不良反应的肺癌患者,在入组当天及入组后第14天、28天、42天、56天观察记录其皮肤不良反应及其他症状表现特点,对其中医证型和病机进行初步归纳分析.结果 纳入患者43例,其中3例脱落,40例纳入分析.入组时患者的皮疹呈针头至粟米大小淡红色丘疹为主,92.5％患者有瘙痒,80％患者出现面红目赤,舌色多红.使用表皮生长因子受体抑制剂后出现痤疮样皮疹时间为(7.85±5.07)天,第14天时达高峰,此后逐渐缓解.第14～28天时25.0％ ～30.0％患者出现脓疱样皮疹,同时有口苦,小便黄,舌红苔黄.第42天以后痤疮样皮疹逐渐稀疏,皮肤干燥明显增多,占85.0％,皮肤干燥出现时间为(32.8±14.91)天;第56天时有92.5％患者出现皮肤干燥,50.0％的患者有3级脱屑,口干鼻干咽干逐渐增多,舌红绛少苔无苔占50.0％.皮疹变化每14天之间比较差异均有统计学意义(P＜0.05或P＜0.01). 结论 应用表皮生长因子受体抑制剂药物的肺腺癌患者出现皮肤不良反应的中医证候呈现出初期为风热证,中期为湿热证,后期为阴虚证.