目的:观察香砂六君子汤合四磨汤加减治疗功能性腹泻(FD)肝气乘脾证的临床疗效及对患者血清胃泌素(GAS)及血浆胃动素(MTL)、血管活性肠肽(VIP)水平的影响.方法:选取72例FD肝气乘脾证患者,按随机数字表法分为对照组和治疗组各36例.对照组给予马来酸曲美布汀片联合双歧杆菌四联活菌片治疗,治疗组给予香砂六君子汤合四磨汤加减治疗.比较2组临床疗效及治疗前后胃肠激素水平、临床症状评分.结果:治疗组总有效率为91.67％,明显高于对照组的66.67％,差异有统计学意义(P＜0.05).治疗后,2组血清GAS水平均较治疗前升高(P＜0.05),血浆MTL、VIP水平均较治疗前降低(P＜0.05);治疗组血清GAS水平高于对照组(P＜0.05),血浆MIL、VIP水平均低于对照组(P＜0.05).治疗后,2组腹痛、腹胀、腹泻评分及症状总分均较治疗前降低(P＜0.05),治疗组腹痛、腹胀、腹泻评分及症状总分均低于对照组(P＜0.05).结论:香砂六君子汤合四磨汤加减治疗FD肝气乘脾证,可改善患者的临床症状,调节胃肠激素水平,疗效优于西药治疗.

目的 分析RigiScan阴茎硬度测量仪对高脂血症患者阴茎夜间勃起指标的检测结果.方法 选取2019年4月1日至2020年3月31日浙江中医药大学附属温州中西医结合医院筛选的符合条件的54例高脂血症患者纳入高脂血症组,另选同期30例血脂正常男性纳入血脂正常组.均采用RigiScan阴茎硬度测量仪进行夜间阴茎勃起功能试验(NPT),测试2晚.并于测试前进行国际勃起功能指数-5(IIEF-5)问卷评估.观察两组测量后夜间阴茎勃起次数、阴茎勃起总持续时间,头部、根部硬度≥60％持续时间,头部、根部的周径变化及时间强度测量值(TAU),并进行比较.结果 高脂血症组ⅡEF-5评分[(16.81±6.41)分]低于血脂正常组[(20.73±3.54)分],差异具有统计学意义(P<0.05).高脂血症组夜间阴茎勃起次数[(4.0±1.3)次]、阴茎勃起总持续时间[(98.21±24.86)min]与血脂正常组[(4.3±1.5)次,(103.55±20.85)min]比较,差异无统计学意义(P>0.05).高脂血症组夜间阴茎头部硬度≥60％持续时间[(46.7±14.4)min]、根部硬度≥60％持续时间[(43.1±22.6)min]均低于血脂正常组[(75.3±17.6)min,(79.2±20.1)min],差异具有统计学意义(P<0.01).高脂血症组阴茎头部的周径变化[(49.69±21.23)％]、根部的周径变化[(40.21±16.16)％]均低于血脂正常组[(73.33±15.57)％,(62.69±17.85)％],差异具有统计学意义(P<0.05);头部TAU(43.37±15.17)、根部TAU(49.10±13.58)均低于血脂正常组(75.72±13.61,68.20±10.15),差异具有统计学意义(P<0.01).结论 高脂血症能显著影响男性勃起功能,是导致男性器质性勃起功能障碍的重要致病因素之一.

目的 通过观察激素性骨坏死模型造模前后骨代谢变化,阐述干预APN-AMPK信号通路调节骨坏死的作用机制.方法 共20只健康成年白兔,随机分为正常组和造模组,每组10只,应用LPS联合醋酸泼尼松龙诱导激素性股骨头坏死模型,疗程为9周.实验过程中记录动物一般情况,造模前后分别对所有兔耳缘静脉取血2 mL,进行ELISA检测;通过病理组织学检查确定造模成功,同时分别进行骨细胞AMPK mRNA表达、TNF-α/OPG相关性分析.结果 造模后,造模组兔血浆APN水平(2.49±0.48)ng/mL,较同组造模前(6.74±0.04)ng/mL比较明显降低,差异有统计学意义(P<0.05);造模组兔骨细胞AMPK mRNA表达为(0.364±0.017),较造模前显著降低,差异有统计学意义(P<0.05).此外,血清APN含量和AMPK mRNA表达与OPG含量呈正相关性,与TNF-α表达呈负相关性.结论 脂联素体内含量可直接引起骨坏死疾病进程,也许APN-AMPK信号通路在疾病转归过程中承担重要角色,通过干预APN-AMPK信号通路正向传导,可以为临床治疗激素性股骨头坏死提供新的思路和方法.

目的 验证塞来昔布对骨关节炎的临床疗效,同时观察其对受试者精子质量的影响.方法 骨关节炎男性患者 70例随机分为治疗组和对照组各 35例.治疗组口服塞来昔布 200mg,每日 1次.对照组使用超声治疗仪,每次治疗 20min,每日 2 次.2组患者采用相同运动处方和运动疗法,疗程均为 8周,1周随访 1次.在治疗前和治疗 4周、8周后分别进行疼痛视觉模拟量表(VAS)、日本骨科协会评估治疗(JOA)和美国西安大略和麦克马斯特大学骨关节炎指数(WOMAC)评分,并进行精子质量检测.结果 2组 VAS,JOA和 WOMAC评分在治疗 4周、8周后均较治疗前显著改善(均 P＜ 0.01),其中治疗组患者比对照组改善更加显著(P＜0.01).治疗组总有效率 94％,对照组总有效率 71％,组间有显著差异(P＜0.05).治疗组精子 DNA完整率在治疗 4 周、8周后分别为(84.5±4.3)％、(82.4±4.2)％,正常精子比例分别为(5.82±0.60)％、(5.83±0.67)％,2组数值均在正常范围内,且与治疗前比较均无显著差异(P＞0.05).结论 塞来昔布对骨关节炎治疗有效且来对患者精子质量造成显著影响.

目的 通过干预脂联素(APN)-单磷酸腺苷活化蛋白激酶(AMPK)信号转导通路,观察股骨头局部血管重建,探讨采用补肾活血方治疗激素性股骨头坏死(SANFH)的作用机制.方法 27只健康成年白兔,随机分为正常组、造模组和实验组,每组9只,应用大肠杆菌脂多糖联合醋酸泼尼松龙诱导SANFH模型.实验组每天采用补肾活血方(5 mL/kg)灌胃,其他两组每天采用生理盐水(5 mL/kg)灌胃,疗程均为8周.实验过程中记录动物一般情况,造模前后、用药8周末分别对所有兔耳缘静脉取血2mL,采用酶联免疫吸附测定法(ELISA)检测APN水平;检测实验组用药前后肿瘤坏死因子·α(TNF-α)、骨保护素(OPG)水平和股骨头B淋巴细胞瘤-2基因(Bcl-2)、半胱氨酸蛋白酶-3(Caspase-3)表达情况,并在用药8周末进行X线检测.结果 造模组造模后APN浓度水平较造模前及正常组均下降(P＜0.05);实验组用药8周末APN水平较造模组升高(P＜0.05);TNF-α免疫组化水平明显下降,OPG免疫组化水平升高,同时股骨头中Bcl-2表达较用药前明显升高,Caspase-3表达水平下降(P＜0.05).结论 补肾活血方通过调节APN-AMPK信号传导通路中APN、TNF-α/OPG、Bcl-2/Caspase-3表达,对兔SANFH发挥有效干预.

[Objective] To investigate the efficacy of Xiangsha Liujunzi decoction and Huangqi Jianzhong decoction on the treatment of gastroduodenal ulcer (deficiency type) and its effects on TGF-α, IL-8 and NO.[Methods]A total of 73 patients with gastroduodenal ulcer (deficiency cold syndrome) were enrolled in our hospital from January 2017 to April 2018. The patients were divided into two groups. The control group was treated with conventional treatment. The observation group was treated with Xiangsha Liujunzi decoction and Huang Qi Jianzhong decoction. The treatment efficiency of the two groups, TCM syndrome scores, human transforming growth factor α (TGF-α), nitric oxide (NO) and interleukin 8 (IL-8), quality of life SF-36 score was compared before and after treatment. [Results]The effective rate of the observation group was 94.7％, which was significantly higher than that of the control group (P=0.01), there was no significant difference in TCM-α, NO and IL-8 between the two groups before treatment. After treatment, the TCM syndrome score of the observation group was significantly lower than that of the control group (P=0.009), TGF-α was significantly higher than the control group (P=0.008), IL-8 in the observation group was significantly lower than that in the control group (P=0.021), and NO was significantly higher than that in the control group (P=0.023). The scores of each item in the observation group quality of life scale SF-36 were significantly higher than those in the control group (P=0.000).[Conclusion]The patients with gastroduodenal ulcer (deficiency cold syndrome) can improve the clinical symptoms and effectively regulate the levels of TGF-α, IL-8 and NO in patients by using Xiangsha Liujunzi decoction and Huangqi Jianzhong decoction.

目的 通过观察中药肉苁蓉治疗骨质疏松症的临床疗效及调控骨代谢组学的相关研究,探讨肉苁蓉防治骨质疏松症的作用机制及临床应用价值.方法 选取2015年6月～2017年6月在我院中医内科、中医骨伤科门诊诊治的70例原发性骨质疏松患者,随机分为治疗组35例和对照组35例.治疗组采取单味肉苁蓉15 g煎汤口服,每日2次;对照组采用口服钙尔奇D片,600 mg/次,每日1次.并于治疗前、治疗3个月和治疗6个月时分别检测骨钙素(BGP)及Ⅰ型胶原羧基端肽(ⅠCTP)水平、血清碱性磷酸酶(ALP)、血钙(Ca)、血磷(P)的水平,同时检测骨密度,并记录中医症状分级及计分,评定临床疗效.结果 治疗组BMD值分别为(0.76±0.04)g/cm2(L2-4)、(0.69±0.06)g/cm2(股骨颈)、(0.51±0.07)g/cm2(大转子),两组治疗前指标比较差异无统计学意义(P>0.05),指标较治疗前明显改善,同时比对照组改善效果更佳.治疗3个月后,治疗组ALP(58.50±18.27)mmol/L、c(Ca)(2.51±0.51)mmol/L、c(P)(1.23±0.01)mmol/L;治疗6个月后,ALP(69.23±16.11)mmol/L、c(Ca)(2.94±0.53)mmol/L、c(P)(1.30±0.38)mmol/L,较对照组各项指标均有明显改善(P<0.05).治疗组治疗3个月、6个月后BGP为(5.48±0.25)μg/L、(7.68±0.10)μg/L,较治疗前升高,且较同期对照组改善更加显著(P<0.05).治疗组治疗3个月、6个月后ⅠCTP为(6.16±0.37)μg/L、(5.40±0.18)μg/L较治疗前降低,同时较同期对照组降低更为明显(P<0.05).经6个月治疗后,治疗组取得57.1％的显著疗效,总有效率91.4％.结论 中药肉苁蓉具有双向调节骨形成和骨吸收的作用,改善血清碱性磷酸酶、钙、磷代谢,提高骨密度,能够有效抗骨质疏松.

Objective:To establish a rabbit model of steroid-induced avascular necrosis of the femoral head(SANFH) by LPS and sodium phosphate solution and to evaluate its validity and death factors with pathological examination.Methods:Twenty healthy adult rabbits with body weight of(2.5 ± 0.2)kg were randomly divided into control group and model group,10 rabbits in each group.The model group received one intravenous injection of LPS(10 μg/kg),and it was repeated after 24 h.After the second injection of LPS,1 injection of dexamethasone sodium phosphate solution (25 mg/kg) was given intramuscularly immediately.The control group was injected with equal amount of saline,every day for 3 times.The general conditions of rabbits were recorded during modeling.The histopathological examination and imaging examination of the femoral head were made after 6weeks.Results:The histopathological examination indicated that the bone trabecula in model group shrinked,collapsed locally and decreased in bone density,and even it was surrounded by connective tissue form a cloud sheet.Light microscopy showed that the nueleus of osteocytes was compressed and the empty lacuna and the fatty cells increased,with the decreasing of bone marrow.Pathological changes in the experimental group included widely liver tissue edema,hyperemia,inflammatory cells infil tration within the portal area,ballooning changes and necrosis in liver cells.The rates of empty lacunae were(9.368± 2.310)％ in control group and(32.500±3.479)％in model group,showing significant difference (P＜0.01).Conclusion:Endotoxin with hormone induction,which is simple and reproducible,can set up animal models in a short time.And the high blood coagulation state of the animal is more in line with the pathological characteristics of steroid-induced avascular necrosis of femoral head.