目的 探讨痛泻要方对肝气乘脾泄泻小鼠肠道微生物的影响,为肝气乘脾泄泻及中医经典药方治疗泄泻的机制提供实验依据.方法 SPF级昆明小鼠随机分为正常组10只和模型组15只,造模成功后,取正常组和模型组各5只,将剩余模型组小鼠随机分为自然恢复组和痛泻要方干预组各5只,痛泻要方干预组灌胃痛泻要方治疗3d,分别在造模成功和治疗后取肠道内容物进行微生物培养,然后记录内容物中各种菌的数量.结果 造模后,模型组小鼠细菌总数、大肠埃希菌、双歧杆菌、乳杆菌的数量均有上升趋势,与正常组相比只有细菌总数[(23.9±3.51)vs(1.35±0.30),108 CFU/g]差异有统计学意义(t=-11.061,P=0.008).治疗后,痛泻要方干预组小鼠恢复了肝气乘脾泄泻引起的肠道微生物失衡,其中与自然恢复组相比痛泻要方治疗对大肠埃希菌的影响最明显[(1.63±1.19) vs (8.47±0.84),106 CFU/g;t=8.124,P=0.001],细菌总数、双歧杆菌、乳杆菌数量均受影响,但差异无统计学意义(P＞0.05).肝气乘脾造模组小鼠的肠道微生物定植抗力(B/E值)降低,而痛泻要方干预组的趋近于正常组.结论 肝气乘脾泄泻小鼠肠道细菌总数、大肠埃希菌、双歧杆菌、乳杆菌等的数量增加,B/E值降低,痛泻要方干预能够恢复肝气乘脾泄泻引起的肠道微生物失衡,并通过调节肠道微生物以提高B/E值来治疗泄泻.

目的:检测肝细胞癌(hepatocellular carcinoma,HCC)患者血清中长链非编码RNA (long non-coding RNA,lncRNA)心肌梗死相关转录本(myocardial infraction association transcript,MIAT)的表达,并探讨其临床意义.方法:qRT-PCR法检测血清MIAT表达;ROC曲线分析其诊断HCC的价值;并研究MIAT表达与疾病进展及预后的关系.结果:MIAT在HCC患者血清中高表达,ROC曲线表明其表达可作为诊断HCC的血清标志物;与临床因素对比后发现MIAT表达与肿瘤数目、TNM分期和BCLC分期密切相关;对血清MIAT水平随访后发现其表达在肝癌肝切除术后降低,并在HCC复发时升高.结论:血清MIAT水平可作为诊断HCC的生物学标志物,其在评估HCC的恶性进展、手术疗效以及预测肿瘤复发方面具有潜在临床应用价值.

Crigler-Najjar综合征(CNS)是由Crigler和Najjar于1952年首次报道而得名,是由尿苷二磷酸葡萄糖醛酸基转移酶(uridine 5'-diphosphate glucuronosyltransferase,UGT)1A1基因突变使其酶活性完全或部分丧失而导致的遗传性胆红素代谢障碍性疾病,分为Ⅰ型和Ⅱ型,发病率为百万分之一[1-3].为常染色体隐性遗传性疾病,临床上甚为罕见,但随着诊疗技术水平的提高,近年CNS的报道有增多趋势[4-5].现就本院1例经分子遗传学诊断确诊的Ⅱ型CNS患者的临床资料进行总结.

目的:观察清脂化瘀汤治疗非酒精性脂肪肝的临床疗效.方法:将90例非酒精性脂肪肝患者随机分为治疗组和对照组各45例,对照组在常规治疗的基础上加用辛伐他汀片治疗,治疗组在对照组治疗基础上加用中药清脂化瘀汤治疗,比较两组肝功能及B超改善情况.结果:治疗组肝功能和B超改善情况均明显优于对照组(P＜0.05);总有效率治疗组为84.4％,对照组为66.7％,组间比较,差异有统计学意义(P＜0.05).结论:应用清脂化瘀汤治疗非酒精性脂肪肝具有良好的效果.

目的:观察HBV相关性慢加亚急性肝衰竭(HBV-ACLF)患者中医症候群积分与病情分期、顸后的相关性.方法:以中医证素研究为理论基础,以湿热、脾虚、血瘀症候群各自中医症候量化表为标准,观察124例HBV-ACLF患者3种症候群积分差异与病情分期及预后的关系.结果:与中/晚期肝衰竭患者比较,早期患者湿热症候群积分较高,血瘀症候群积分较低,差异均有统计学意义(P＜0.05);血瘀症候群积分为肝衰竭早期患者预后影响因素(OR＞1),脾虚症候群积分为肝衰竭中/晚期患者预后影响因素(OR＞1).结论HBV-ACLF早期以湿热症候群表现为主,中晚期以血瘀、脾虚症候群表现为主;血瘀、脾虚症候群积分为预后影响因素之一.

目的：探析非酒精性脂肪肝应用茵陈五苓散治疗的临床效果。方法：选取笔者所在医院2013年1月-2014年1月收治的100例非酒精性脂肪肝患者作为研究对象，按照随机数字表法将其分为观察组和对照组，每组50例。观察组茵陈五苓散治疗，对照组采用口服脂必妥治疗，两组均治疗2个月，治疗后比较两组的临床效果及治疗前后肝功能指标变化。结果：观察组的治疗总有效率88.0%明显高于对照组的56.0%，差异有统计学意义(字2=12.70，P<0.01)；观察组治疗后的γ-转肽酶(γ-GT)、碱性磷酸酶(ALP)、谷草转氨酶(AST)、谷丙转氨酶(ALT)等肝功能各项指标均明显优于对照组，差异均有统计学意义(t=23.88、24.37、30.39、30.62，P<0.01)。而两组治疗前以上各观察指标均无统计学意义(P>0.05)。结论：采用茵陈五苓散治疗非酒精性脂肪肝的临床效果确切，可明显改善患者的肝功能，值得临床推广。

目的观察补肾解毒法联合α干扰素治疗慢性乙型肝炎的临床疗效。方法 37例慢性乙型肝炎患者随机分为治疗组和对照组,治疗组用α干扰素联合补肾解毒法治疗,对照组用α干扰素治疗。两组疗程均为24周,观察两组用药后临床疗效及不良反应。结果两组治疗后肝功能指标(ALT、AST、TBIL)均有改善,与治疗前比较,差异有显著性(P<0.05);治疗组的HBV-DNA阴转率优于对照组(P<0.05),治疗组HBeAg阴转率与对照组比较,差异无显著性(P>0.05);两组不良反应发生率无明显差异(P>0.05)。结论补肾解毒法可提高α干扰素治疗慢性乙型病毒肝炎的疗效。

Objective: To observe the efficacy and safety of the TCM differentiation treatment combined with IFN-for chronic hepatitis B with HBeAg-positive.Methods: According to the method of the prospective cohort study,137 patients with the disease were divided into TCM combined with IFN-treatment group and IFN-control group.Results: After 48 weeks of treatment in both treatment and control group,the normalization rates of ALT were 54.8% and 42.7%respectively(P0.05);the patients proportion of HBV-DNA below the detection value were 47.06% and 34.78% respectively(P0.05);the HBeAg negative conversion rates were 50.0% and 34.8% respectively(P0.05);and the HBeAg seroconversion rates were 50.0% and 30.4% respectively(P0.05).The incidence of adverse events in both groups were similar,but the incidence of fatigue and decreased appetite were 15.5% and 28.9% respectively(P0.05).Conclusion: The therapy of differentiation in TCM combined with IFN-can increase HBeAg seroconversion rate of the chronic hepatitis B patients with HBeAg-positive and improve IFN-induced fatigue,decreased appetite and other adverse reactions.

Objective:To observe the therapeutic efficacy and safety on chronic severe hepatitis(CSH) patients of Yanghuang and Yinhuang syndrome type by principles of detoxicating and stasising combined with warming-Yang and strengthening-Pi(PA)or with nourishing-Qi and strengthening-Pi(PB),respectively.Methods:Fifty-six patients with CSH were randomly divided into two groups,group A(28 cases) treated with PA and group B(28 cases) with PB,for 4 weeks,level of serum bilirubin,PTA,ALT and adverse events were observed.Results:The efficient was 88.9%(24 /27),73.1%(19 /26) in group A and group B respectively.Level of serum bilirubin was significantly lower in both groups,but the descending extent in group A was greater,compared with group B(213.6±87.1) and(140.7±90.3)μmol/L,respectively.The thrombinogen activity was higher in group A than that in group B after treatment(P0.05),no significant difference in ALT was found between the two groups.The incidence of spontaneous bacterial peritonitis in group A(3/27) was less than that in group B(7/26),no infection,bleeding and other adverse reactions was observed in group A.Conclusion: Warm therapy is efficacy and safety in patients with CSH with Yanghuang and Yinghuang syndrome type.

目的 观察益气活血消臌汤合葶苈大枣泻肺汤治疗肝性胸水的临床疗效.方法 以益气活血消臌汤合葶苈大枣泻肺汤治疗肝性胸水40例,并与西医常规治疗40例对比疗效.结果 治疗组疗效优于对照组.结论 益气活血消臌汤合葶苈大枣泻肺汤有较好的治疗肝性胸水的作用.

<正>随着现代经济社会的快速发展,人们生活和工作节奏的加快,各方面的压力不断增加,失眠是最常见的睡眠障碍,不仅严重影响人们的正常生活和工作,长期失眠还可导致抑郁或其他生理、心理问题,从而带来严重的社会问题。笔者在临床上从肝

目的观察益气活血消臌汤治疗难治性乙型肝炎肝硬化腹水的临床疗效。方法将60例乙型肝炎肝硬化腹水患者随机分为治疗组(益气活血消臌汤结合西药常规治疗)和对照组(西药常规治疗)各30例,治疗1个月后,观察症状和体征、肝功能指标、血钠、尿钠与尿钾、尿素氮、血肌酐、腹水的变化。结果治疗组能明显的退黄、降酶和升高白蛋白(P﹤0.05,P﹤0.01),能明显的升高血钠、尿钠/尿钾(P﹤0.05),降低尿素氮、血肌酐(P﹤0.05);治疗组总疗效优于对照组(P﹤0.05)。结论益气活血消臌汤治疗难治性乙型肝炎肝硬化腹水有较好的临床疗效。

目的观察解毒化瘀汤合乌梅承气汤治疗慢性乙型肝炎慢加急（亚急）肝衰竭早中期的临床疗效。方法将慢性乙型肝炎慢加急（亚急）肝衰竭患者80例随机分为两组，治疗组40例口服解毒化瘀汤合乌梅承气汤保留灌肠，并配合常规西医治疗；对照组40例予常规西医治疗。比较两组治疗后症状、体征、肝功能、凝血酶原活动度（PTA）、血氨（NH3）改善情况。结果治疗组疗效优于对照组，其总胆红素（TBIL）、丙氨酸氨基转移酶（ALT）、NH3明显降低，PTA升高，与对照组比较差异显著；特别在改善肠道感染、肝性脑病方面，治疗组疗效优于对照组。结论解毒化瘀汤合乌梅承气汤能提高慢性乙型肝炎慢加急（亚急）肝衰竭早中期的疗效，改善其并发症。

<正>自发性细菌性腹膜炎(SBP)是肝硬化常见并发症及导致肝硬化患者死亡的主要原因之一。近年来,笔者采用中满分消丸联合头孢噻肟钠治疗肝炎肝硬化合并自发性细菌性腹膜炎取

目的观察解毒化瘀汤联合中药保留灌肠治疗肝衰竭的临床疗效。方法将60例肝衰竭患者随机分为治疗组与对照组各30例,均给予西医护肝综合治疗,治疗组加以口服解毒化瘀汤联合中药保留灌肠;比较两组TBiL、PTA、NH3、LPS等指标改善情况。结果治疗后治疗组TBiL、PTA、NH3、LPS指标、总有效率、肝性脑病发生率与对照组比较,差异均有显著性。结论解毒化瘀汤联合中药保留灌肠治疗肝衰竭在改善肝功能、防治肝性脑病方面疗效显著。

OBJECTIVE:To explore the nature of pathology of sluggishness of lung-defensive qi and to offer objective experimental indexes for weifen syndrome (defensive phase syndrome). METHODS:According to the completely random design, the plasma levels of vasoactive intestinal peptide (VIP) and thromboxane B2 (TX2) of 19 patients with weifen syndrome and 13 patients with qifen syndrome (qi phase syndrome) were detected by radioimmunoassay. The plasma levels of VIP and TX2 at different stages of weifen syndrome and qifen syndrome were observed. RESULTS:The plasma levels of VIP in weifen syndrome and in the late stage of weifen syndrome increased greatly at different stages as compared to qifen syndrome and the blank group (P < 0.01), while the plasma level of TX2 of weifen syndrome was higher only at the late stage than the blank group and qifen syndrome (P < 0.01). As for the levels of VIP and TX2 in weifen syndrome with different internal organs infected, there was no significant difference (P > 0.05). CONCLUSION:VIP may be an index reflecting the pathology of weifen syndrome, and it is one of the material foundations of sluggishness of lung-defensive qi, but it has nothing to do with the infected internal organs. The level of TX2 increases only after the fever of patients with weifen syndrome subsided, so it can not be the basis for diagnosis of the early stage of weifen syndrome. It doesn't increase in qifen syndrome either, the mechanism remains to be further studied.

目的:观察益气化瘀消水汤联合中药敷脐治疗肝硬化腹水的临床疗效.方法:选择失代偿期肝硬化病例79例,随机分为治疗组(48例)和对照组(31例),在综合治疗基础上,治疗组口服益气化瘀消水汤,并联合中药敷脐,观察两组病例主要症状及体征变化,以及对肝、肾功能、PTA等方面的影响,并进行统计学分析.结果:治疗组24小时尿量增加明显,腹水消退时间短,在肝、肾功能、PTA、ALb等方面的改善明显优于对照组,总有效率达85.4%.结论:益气化瘀消水汤联合中药敷脐治疗肝硬化腹水,能有效改善临床疗效,简、便、验、廉,毒副作用小,值得临床推广.

选取慢性乙型病毒性肝炎患者中医辨证属肝郁脾虚证者33例,随机分为清热解毒化浊片治疗组15例,疏肝理脾片对照组18例.结果:清热解毒化浊片在改善症状、降低ALT、CG及退黄方面与疏肝理脾片无差异;清热解毒化浊片还可降低AST、HA,而疏肝理脾片对此疗效无统计学意义.清热解毒化浊片与疏肝理脾片都能降低血浆内毒素水平,但疏肝理脾片治疗前后无统计学差异.表明:清热解毒化浊片对肝郁脾虚型患者有一定的护肝、抗肝纤维化的疗效,其机理可能是通过降低血浆内毒素水平,来阻断肝损害的恶性循环.

目的:观察大黄煎剂保留灌肠治疗慢性重型肝炎的疗效.方法:选择慢性重型肝炎(早、中期)患者,随机分为治疗组(98例)和对照组(58例),在综合治疗相同基础上,治疗组联合应用大黄煎剂保留灌肠,观察两组患者主要症状、体征等变化及并发症与病死率情况,以及对肝、肾功能、血氨、凝血酶原活动度的影响,并进行统计学分析.结果:联合应用大黄煎剂保留灌肠治疗慢性重型肝炎,能有效改善临床症状,恢复肝脏功能,降低血氨浓度,减少并发症,降低病死率,明显优于对照组.结论:大黄煎剂保留灌肠治疗慢性重型肝炎,安全、有效、价廉,值得进一步推广.

急性黄疸型病毒性肝炎是临床较常见疾病,我们于2001年10月～2003年5月将我科收治的急性黄疸型病毒性肝炎患者144例随机分为2组,分别用中医清热解毒法和利湿化浊法为主进行治疗,对应方药选用急肝方和甘露消毒丹(其中急肝方为我传染科协定处方),进行临床疗效对比观察,现报道如下.