目的 评价围绝经期一日门诊多学科健康宣教模式对妇女绝经激素治疗(MHT)人知的影响.方法 介绍重庆医科大学附属第三医院于2017年开设的围绝经期一日门诊:由医师、药师、营养师、音乐心理治疗师、护师等多学科成员参与,为围绝经期或即将步入围绝经期的妇女(称为"学员")提供系统化、全方位、人文化、面对面的团体式科普宣教、实操体验和答疑.选取2020年参加该一日门诊的学员作为调查对象,自行设计调查问卷并分析学员对围绝经期综合征的了解程度以及对MHT的知晓率、使用意愿及担忧情况.结果 共295名学员完成问卷调查,与参加前比较,学员参加一日门诊后,对围绝经期年龄段(96.61％ vs.99.32％,P=0.037)、围绝经期保健知识重要性(91.19％ vs.96.95％,P＜0.001)、围绝经期综合征是否需要治疗(88.47％vs.99.32％,P＜0.001)、使用MHT的意愿率(70.59％vs.94.48％,P＜0.001)、MHT应何时开始使用(60.50％vs.95.17％,P＜0.001)、降低心血管疾病风险(51.68％vs.96.55％,P＜0.001)、延缓衰老(69.75％ vs.97.59％,P＜0.001)、预防骨质疏松症(65.13％ vs.97.59％,P＜0.001)等方面的认知水平均显著提高,且医务人员高于非医务人员(P＜0.05).90％的学员表示收获了常见病的防治、饮食和营养指导、心理调节指导、激素治疗相关知识、锻炼身体方法;愿意接受1～5年使用MHT的比例(31.09％vs.47.93％)明显升高;对血栓风险(60.24％vs.36.81％)、体质量增加(59.64％vs.14.84％)、终身依赖(52.41％vs.18.13％)的顾虑比例明显降低,但对肿瘤风险顾虑没有减少.学员中非医务人员的MHT使用率从2017年的2.22％增长至2020年的62.16％.结论 围绝经期一日门诊多学科健康宣教模式可提高围绝经期妇女对MHT的正确认识水平、消除认知误区,提高MHT使用率.

目的:了解"一日门诊"持续性综合管理更年期参与者的真实体验,为更年期女性健康管理进一步实施提供依据.方法:采用目的抽样法,选取参加"一日门诊"持续性综合管理的更年期病人22例进行深度访谈,运用Colaizzi现象学研究法,对访谈资料进行整理和分析.结果:共提炼出更年期症状改善积极体验、更年期心理积极体验、强化自我健康管理意识和行为、提高更年期就医的准确性4个一级主题.结论:"一日门诊"持续性综合管理模式,可改善更年期病人的身心体验,增强自我健康管理意识和行为.

目的 观察电针对中老年男性部分雄激素缺乏综合征(PADAM)模型大鼠睾丸间质细胞(Leydig细胞)的作用,并探讨电针抗雄性生殖衰老的可能作用机制.方法 18只SD PADAM大鼠随机分为老年组、药物组、电针组,每组6只,SD青年大鼠6只作为青年组.青年组和老年组给予0.9％氯化钠溶液[7 mg/(kg·3d)]腹部皮下注射.药物组予丙酸睾酮注射液[7 mg/(kg·3d)]腹部皮下注射.电针组取"肾俞""关元"穴进行干预.治疗时间均为8周.观察治疗前后各组大鼠强迫游泳力竭时间,采用ELISA检测各组大鼠血清总睾酮(TT)和游离睾酮(FT)水平,采用免疫组化法检测Leydig细胞Keleh样环氧氯丙烷相关蛋白-1(Keap1)蛋白表达,Western Blot检测大鼠睾丸Keap1、核因子E2相关因子2(Nrf2)、醌氧化还原酶1(NQO1)及超氧化物歧化酶(SOD)蛋白表达.结果 与青年组比较,老年组治疗前强迫游泳力竭时间、血清TT、FT水平及睾丸Nrf2、NQO1、SOD1蛋白表达降低(P＜0.01),睾丸Keap1蛋白表达增加(P＜0.01).与老年组比较,电针组与药物组治疗后强迫游泳力竭时间、血清TT、FT及睾丸Nrf2、NQO1、SOD1蛋白表达升高(P＜0.01),睾丸Keap1蛋白表达降低(P＜0.01).结论 电针可改善睾酮低下老年大鼠血清TT、FT含量,提高老年大鼠抗疲劳能力,其作用机制可能与调控Keap1-Nrf2/ARE信号通路,降低老年大鼠睾丸组织氧化应激损伤有关.

随着人口老龄化的加剧,抗衰老已成为当今医学研究的热点领域.中医抗衰老有着两千多年的丰富经验,在长期的临床实践中,形成了独具特色的方法和理论体系,针灸在延缓衰老方面颇具特色和优势.文章从现代医学和中医学两个角度对衰老机制的研究认识进行比较,并对近年来针灸抗衰老的机制进行总结综述.

OBJECTIVE:To observe the effect of electroacupuncture (EA) on anti-oxidant function of Leydig cells in aged rats with low testosterone, so as to reveal its underlying mechanism of anti-aging of male reproduction. METHODS:Eighteen 20 months old SD rats were divided into aged control, medication and EA groups(n=6 in each group), and other 6 young male SD rats (2 months of age) were used as the youth control group. The rats of the youth and the aged control groups received subcutaneous injection of 0.9% normal saline (7 mg·kg-1·3 d-1) for 8 weeks, and those of the medication group received abdominal subcutaneous injection of Testosterone Propionate (7 mg·kg-1·3 d-1) for 8 weeks. EA (2 Hz/100 Hz, 1 mA) was applied to bilateral "Shenshu" (BL23) and "Guanyuan" (CV4) for 15 min, once daily for 8 weeks except the weekends. The levels of serum total testosterone (TT) and free testosterone (FT) were determined by enzyme linked immune sorbent assay (ELISA), the immunoactivity of phosphorylated extracellular signal-regulated protein kinase (p-ERK) was detected by immunohistochemistry, and the expression levels of ERK, p-ERK, nuclear factor erythroid 2-related factor 2 (Nrf2) and heme oxygenase-1 (HO-1) proteins in the testis tissues were determined by Western blot. RESULTS:Before and after the treatment, the levels of serum TT and FT in the aged control group were significantly lower than those of the youth control group (P<0.01). After the treatment, the serum TT and FT contents in the EA and medication groups were obviously higher than those in the aged control group (P<0.01). Compared with the youth control group, the expression levels of ERK, p-ERK, Nrf2 and HO-1 proteins were significantly down-regulated in the aged control group (P<0.01), while in comparison with the aged control group, the expression levels of ERK, p-ERK, Nrf2 and HO-1 proteins were significantly up-regulated in the medication and EA groups (P<0.01). The therapeutic effect of EA was notably superior to that of medication in up-regulating the immunoactivity of p-ERK, and the expression levels of ERK, p-ERK, Nrf2 and HO-1 proteins (P<0.01). No significant differences were found between the EA and medication groups in the increased levels of serum TT and FT after the intervention (P>0.05). CONCLUSION:EA intervention may increase testosterone level of the aged rats, which may be related to its effects in triggering ERK /Nrf2 /HO-1 signaling (anti-oxidative stress signal pathway) in the testis.

OBJECTIVE:To observe the effect of electroacupuncture (EA) on the expression of apolipoprotein E (ApoE) and related proteins of inflammation and anti-oxidative stress in spinal cord in mice with spinal cord injury (SCI), so as to explore its mechanisms underlying function repair. METHODS:Thirty-six female C57BL/6 mice were equally randomized into 3 groups: sham operation, model and EA. The SCI model was established by clamping the spinal cord for 25 s with a serrefine after laminectomy of the 1st lumbar vertebra (L1). EA (1.5 Hz/7.5 Hz, 1.0 mA) was applied to bila-teral "Zusanli" (ST36) and "Sanyinjiao" (SP6) for 10 min, once a day for 7 days. The hindlimb locomotor function was assessed according to the state of the range of motion, coordination, claw gesture of the hind leg ankle-joint, trunk stabi-lity and the tail posture by using Basso Mouse Scale(BMS). The histopathological changes of the injured area of the spinal cord were determined by H.E. staining. The expression levels of ApoE, phosphorylated nuclear transcription factor-κB(p-NF-κB), interleukin 1 beta(IL-1β), phosphorylated extracellular regulatory protein kinase(p-ERK1/2), extracellular regulatory protein kinase(ERK1/2), nuclear factor erythroid 2-related factor 2(Nrf2) and heme oxidase-1(HO-1) in the spinal cord were detected by Western blot, and the glial fibrillary acidic protein (GFAP)-positive astrocytes were displayed by immunofluorescence staining. RESULTS:After modeling, the BMS scores were significantly decreased in the model group compared with the sham operation group (P<0.05). Following EA, the BMS scores were markedly increased in the EA group relevant to the model group (P<0.05), suggesting an improvement of the hindlimb locomotor function. H.E. stain showed structural disorder with lots of cavities, severe inflammatory infiltration with large quantity of inflammatory cells, and apparent reduction of normal neurons in the injured spinal cord tissue of model group, which was milder in the EA group. The expression levels of ApoE, p-NF-κB, IL-1β, p-ERK1/2 (not ERK1/2), Nrf2 and HO-1 were significantly increased in the model group than those in the sham operation group (P<0.05). Compared with the model group, the expression levels of ApoE, p-ERK1/2, Nrf2 and HO-1 were further notably up-regulated (P<0.05), and those of p-NF-κB and IL-1β proteins obviously down-regulated in the EA group (P<0.05). Immunoflorescence staining showed that the number of GFAP-positive cells was apparently increased in the model group compared with the sham operation group and observably decreased in the EA group relevant to the model group (P<0.05). CONCLUSION:EA can significantly improve locomotor function in SCI mice, which is associated with its effects in reducing inflammation, oxi-dative stress reactions and reactive astrocyte proliferation via up-regulating expression of ApoE, p-ERK1/2, and Nrf2/HO-1 (antioxidant pathway) and inhibiting IL-1β and NF-κB expression.

目的 探讨中国西南地区慢性肾脏病(CKD)人群高磷血症与动脉粥样硬化(AS)危险性的相关性.方法收集2013年1月-2016年2月重庆医科大学附属第一医院肾脏内科收治的CKD患者922例的临床资料进行横断面研究.将患者按照有无动脉粥样硬化病变分为动脉粥样硬化组(AS)与非动脉粥样硬化组(non-AS),将性别、年龄按1:1配对后共纳入438例患者,每组219例.血清磷浓度则按四分位间距分为:<1.22mmol/L、1.22～1.46mmol/L、1.47～1.78mmol/L、>1.78mmol/L四个水平.采用logistic回归分析不同程度高磷血症对CKD患者动脉粥样硬化发生率的影响.结果438例CKD患者,总体透析率59.8％(262例),高磷血症者占49.5％(217例).单因素logistic回归分析结果显示,高磷血症、维持性透析、CKD 4-5期、高血压、降压药物的使用、糖尿病、血糖控制情况、血清镁,以及CK-MB水平与CKD患者动脉粥样硬化发生率均呈正相关(P<0.05).将以上相关因素纳入多因素logistic逐步回归分析排除混杂因素影响,结果显示,CKD患者动脉粥样硬化病变发生率与血磷水平1.47～1.78mmol/L(P=0.001)、>1.78mmol/L呈明显正相关(P<0.001),并随着血磷水平增高,其发生动脉粥样硬化的风险增大(血磷水平1.47～1.78mmol/L:OR=2.85;血磷水平>1.78mmol/L:OR=3.57).结论高磷血症是中国西南地区CKD患者发生动脉粥样硬化病变的独立危险因素.