目的 检测老年射血分数中间值心力衰竭(HFmrEF)患者血清可溶性CD146(sCD146)的水平,探讨其对老年HFmrEF患者的临床诊断价值.方法 选取2020年9月至2021年10月间牡丹江医学院附属红旗医院老年病科和心血管内科就诊射血分数(LVEF:40％～49％)、纽约心功能分级(NYHA分级)Ⅱ级～Ⅳ级的老年心衰患者34例(老年HFmrEF组),非老年心衰患者34例(非老年HFmrEF组),同期健康体检老年者31例(健康老年组)作为研究对象.收集所有患者的年龄、性别、血压、心率、总胆红素、血肌酐、胆固醇等数据,所有患者均常规行超声心动图检查,检测血清N末端前体脑利钠肽(NT-proBNP)、sCD146水平.比较各组患者的一般资料、NT-proBNP、超声心动图相关指标、sCD146水平的差异,分析相关性,受试者工作特征曲线(ROC)评价sCD146对HFmrEF的诊断价值.结果 三组患者收缩压、舒张压、血浆白蛋白、胆固醇、低密度脂蛋白无显著性差异(P>0.05),而心率、总胆红素、同型半胱氨酸、血肌酐有明显差异(P<0.05);三组研究对象左室后壁厚度、每搏输出量无统计学意义(P>0.05),而左心室室间隔厚度、左室舒张末期前后径、左室收缩末期前后径、左室舒张末期容积中有显著差异(P<0.05);三组患者的血清NT-proBNP、sCD146水平有显著性差异(P<0.05),且HFmrEF患者的NT-proBNP、sCD146浓度均显著高于健康老年组患者;老年HFmrEF组与非老年HFmrEF组,sCD146与NT-proBNP、心功能分级呈正相关;sCD146诊断HFmr EF的曲线下面积为:0.945(95％CI:0.894,0.996),最佳截断值:68.459 ng/mL,灵敏度、特异度分别为:85.3％、93.5％.结论 血清sCD146浓度在老年HFmrEF、非老年HfmrEF显著升高,sCD146对老年HFmrEF的诊断和病情评估有意义;老年HFmrEF患者血清sCD146与NT-proBNP、心功能分级具有相关性.

营养不良在慢性阻塞性肺疾病(COPD)患者中发生率日益增加,已被证实营养不良会加重COPD病情的进展,严重者会出现肺恶病质,甚至增加疾病的死亡率.营养不良可作为COPD患者预后不良的独立危险因素,因此对COPD患者进行及时有效的营养状况的诊断和干预是临床工作中不可或缺的一部分.本研究从COPD合并营养不良的病因及发病机制、对机体的影响、营养支持等方面进行阐述,以期引起临床工作的高度重视,及早发现COPD患者营养不良的风险,及时给予合理恰当的营养支持,对于提高患者的生活质量,降低COPD患者急性加重的风险,延缓疾病进程具有重要的理论和现实意义.

目的 探讨涎液化糖链抗原-6(kerbs von den lungen-6,KL-6)在老年特发性肺纤维化(idiopathic pulmonary fibrosis,IPF)诊断和治疗中的评估价值.方法 选取2018年7月至2019年11月牡丹江医学院附属红旗医院收治的普通型间质性肺炎型IPF患者68例,其中老年患者36例(老年IPF组)、非老年患者32例(非老年IPF组),另择同期老年健康体检者32例(老年健康组)作为对照.采用酶联免疫吸附试验测定血清KL-6表达水平,记录所有IPF患者的肺功能指标,并对其普通型间质性肺炎病变程度进行评估.比较各组血清KL-6的表达水平及肺部高分辨率CT(HRCT)评分,分析KL-6与肺功能指标和肺部HRCT评分的相关性.多组间的比较采用方差分析(进一步两两比较采用LSD-t检验)或秩和检验,计数资料的比较采用χ2检验;相关关系采用Pearson相关分析或Spearman秩相关分析.结果 3组患者KL-6表达水平的差异有统计学意义(F=63.425,P<0.05),其中老年IPF组明显高于非老年IPF组和老年健康组(P<0.01).ROC曲线显示,KL-6诊断老年IPF的临界值为516.21 U/ml,此时敏感度和特异度最高,分别为94.4％和87.5％.无论是老年IPF组还是非老年IPF组,急性加重患者血清KL-6表达水平均明显高于稳定患者(t=2.843、2.215,P<0.05或0.01);老年IPF组中急性加重患者血清KL-6表达水平均明显高于非老年IPF组(t=2.657,P<0.05).相关分析显示,无论是68例IPF患者还是老年IPF组患者,其KL-6水平与HRCT评分均呈正相关(r=0.748、0.699,P<0.01).老年IPF患者血清KL-6表达水平与部分限制性通气功能和弥散功能指标呈负相关(r=-0.515、-0.393、-0.384,P<0.05).结论 血清KL-6对诊断IPF有一定临床意义,尤其对于老年患者具有较高的诊断敏感度及特异度,且与疾病严重程度及治疗效果呈现一定相关性.

苓甘五味姜辛汤临床上多用于治疗迁延性咳嗽、感冒后顽咳、变异性哮喘、慢性肺源性心脏病、中晚期肺癌等. 本文将近年来对于苓甘五味姜辛汤的实验室研究及临床研究进行总结,讨论苓甘五味姜辛汤的运用机制、应用趋势及其应用于老年哮喘-慢性阻塞性肺疾病( COPD)重叠综合征的可能性.

目的 观察西药联合苓甘五味姜辛汤治疗老年人哮喘-慢性阻塞性肺疾病重叠(ACO)的疗效.方法 ACO老年患者随机分为例数相等的两组,入院后均予以常规西药治疗,同时治疗组49例予以苓甘五味姜辛汤免煎颗粒,观察两组治疗达缓解的时间,并于急性期前后行肺功能检查、应用慢性阻塞性肺疾病症状评分表(CAT)、哮喘症状评分表(ACT)进行评分.稳定期出院后两组均使用布地奈德福莫特罗粉吸入剂长期吸入治疗,治疗组在此基础上加用苓甘五味姜辛汤免煎颗粒.两组皆于出院后1、3、6个月接受ACT、CAT评分,随访再发作频率、肝肾功能.结果 治疗组达缓解时所需时间较观察组明显缩短(t=2.072,P<0.05),治疗组在ACO急性期前后肺功能改善更显著(P<0.05).随访期间,治疗组出院后1、3、6个月时CAT及ACT评分改善较观察组明显(P<0.05);同时,治疗组副作用发生相对较少(P<0.05)、急性发作次数少(P<0.05).随访期无急性发作时两组患者均未见肝肾功能异常.结论 常规西药联合苓甘五味姜辛汤对老年人ACO的治疗有促进作用,患者服用过程中未见不适,激素相关副作用较少见,长远使用更有优势.

目的:从免疫衰老的角度分析和比较四种经典补肾方(六味地黄丸、金匮肾气丸、左归丸和右归丸)对D-半乳糖致亚急性衰老大鼠免疫相关因子的影响变化.方法:观察六味地黄丸、金匮肾气丸、左归丸、右归丸及四方共有“三补”药物组对D-半乳糖(D-gal)致亚急性衰老模型大鼠血清白介素-1(IL-1)、白介素-2(IL-2)、白介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)含量及肾脏表面生长因子(EGF)表达的影响.结果:亚急性衰老大鼠血清IL-1、IL-8、TNF-α含量升高、IL-2含量下降,肾脏EGF表达水平下调;与模型组相比,5个给药组对IL-2和EGF均有升高作用,右归丸对IL-1、IL-8和TNF-α均无显著性作用,左归丸对IL-8、TNF-α含量具有降低作用,金匮肾气丸、三补药物组对IL-1、IL-8含量无显著作用但对TNF-α有显著降低作用,六味地黄丸可以降低IL-1、IL-8、TNF-α含量.结论:四种经典补肾方和四方共有的三补药物组对炎症保护因子IL-2和EGF在肾脏的表达均有明显的上调作用;对于致炎因子IL-1、IL-8和TNF-α的降低作用六味地黄丸效果最好也最全面,金匮肾气丸、三补药物组和左归丸只对其中一或两种因子有降低作用,右归丸对这3种指标均无显著性作用.5组观察药物可能是通过抑制白介素和TNF-α等致炎因子和促进EGF的保护作用来调整亚急性衰老模型大鼠的免疫机能,抑制炎症损伤,从而达到延缓衰老的效果.四方存在补泻配伍方式的不同,相对来说六味地黄丸的作用更为明显和稳定,说明恰当的配伍对中药复方疗效的强度和稳定性具有重要作用.另外补益药的主要作用可能主要在于提高机体对伤害因素的防御作用,而不能抑制和消除一些对机体有伤害的因素,即“正气存内,邪不可干”.

Objective To analyze the influence of standardized anti-heart failure treatment combined with Fasudil on plasma BNP and cardiac function in elderly patients with heart failure. Methods Totally 60 elderly patients with heart failure admitted to our hospital from October 2014 to October 2016 were randomly divided into 2 groups,30 cases in each group. The control group was given stan-dardized anti-heart failure treatment,on this basis,the Fasudil group was added Fasudil. The total effective rate of heart failure and the incidence rate of adverse reaction were compared between the 2 groups,and the difference of 24 h urine volume,left ventricular end diastolic diameter ,left ventricular ejection fraction and plasma BNP before and after intervention were compared between the 2 groups. Results The total effective rate of heart failure in the Fasudil group was significantly higher than that in the control group(P < 0. 05);the adverse reactions in the 2 groups were similar(P > 0. 05). Before the intervention,the 24 h urine volume, left ventricular end diastolic diameter,left ventricular ejection fraction and plasma BNP in the two groups were similar(P > 0. 05), after the intervention,those indexes in the Fasudil group were significantly better than those in the control group(P < 0. 05). Conclusion Standardized anti-heart failure treatment combined with Fasudil for treating elderly patients with heart failure can sig-nificantly reduce plasma BNP,improve heart function and the patients′ prognosis,it is high safety without obvious adverse reactions, which is worthy of clinical promotion.

Objective:To analyze and compare the effect of the two classical formula with action of nourishing yin,Zuogui Pill and Liuwei Dihuang Pill,which have different compatibility characteristics,and to investigate relevant immune factors influenced by "Sanbu" (three medicinal with supplementing function),which is common to both formula,in subacute aging rats induced by D-galactose.Methods:The content of IL-1,IL-2,IL-8,TNF-α,and the expression of EGF in sub-acute aging rats were observed after the intervention with Zuogui Pill,Liuwei Dihuang Pill and "Sanbu".Results:After modeling,the content of IL-1,IL-8 and TNF-α were increased,but the content of IL-2 and the expression of EGF were decreased.Compared to the model group,the levels of IL-1 and TNF-α were degraded,and IL-2 level and EGF expression were raised obviously by the medications;IL-8 content was decreased obviously by Liuwei Dihuang Pill,however,there were no significant reducing effect in the other two groups.Conclusion:There are different inhibition effect on IL-1 and TNF-α,and up-regulation effect on IL-2 and EGF in sub-acute aging rats,when they are treated by Zuogui Pill,Liuwei Dihuang Pill,or "Sanbu",which may be related to the inhibition of the inflammatory factors and the adjustment of immune protective effect.There are different compatibility pattern in terms of reinforcing and reducing in the two formulas;comparatively,the effect of Liuwei Dihuang Pill is more obvious and stable,which shows appropriate compatibility playing an important role on the strength and stability of Chinese medicine formula.

老年人慢性胃炎的发病率明显高于年轻人〔1〕，并且老年慢性胃炎具有病势缠绵难愈，易于复发和癌变的特点。本文观察具有健脾行气作用的枳术散治疗老年慢性胃炎的疗效。

OBJECTIVE:To develop a method for the content determination of catalpol in Zuogui pills.METHODS:RP-HPLC system was used.The determination was performed on Eclipse XDB-C 18 column with acetonitrile-water(0.7:99.3,V/V) as mobile phase at the flow rate of 1.0 ml/min.Column temperature was 25 ℃.The detection wavelength was set at 210 nm and injection volume was 5 μl.RESULTS:The linear range of catalpol was 0.006 7-0.216 0 mg/ml(r=0.9996)with an average recoveries of 98.5%(RSD=1.72%,n=5).CONCLUSION:The method is rapid,simple,accurate and reliable.It can be used for the content determination of catalpol in Zuogui pills.

目的:观察咳尔康口服液对血管紧张素转化酶抑制剂(ACEI)诱发咳嗽的治疗效果.方法:选择符合纳入标准的ACEI诱发咳嗽患者148例随机分为治疗组(76例)和对照组(72例),治疗组口服咳尔康口服液(发明专利号ZL2009 10071953.6)10ml,每日3次;对照组给予安慰剂(外包装及药物颜色均与咳尔康口服液一致)10ml,每日3次口服;4周为1个疗程,观察两组患者治疗前后症状体征改善情况.结果:治疗组76例,显效55例,3个月随访过程中,22例无复发,16例于3个月内复发,9例于2个月内复发,8例于1个月内复发;18例有效,3例无效,总有效率96.05％.对照组72例,显效2例,有效19例,无效51例,总有效率29.17％,治疗前后主要症状积分变化有显著性差异(P＜0.01);与对照组相比,差异具有统计学意义(P＜0.01).结论:咳尔康口服液能有效缓解ACEI制剂诱发的咳嗽,疗效确切,方法简单安全,值得在临床上推广应用.

目的:观察咳尔康口服液配合西药治疗慢性支气管炎急性发作期的临床疗效.方法:将 94 例慢性咳嗽患者随机分为治疗组47例和对照组47例.治疗组常规西药治疗的同时给予中药制剂咳尔康口服液,对照组给予常规西药治疗,疗程7d～10天.结果:治疗组的总有效率为95.74%,对照组的总有效率为87.23%,两组治疗后疗效积分对比有显著性差异,总体统计分析治疗组疗效优于对照组.结论:以培土生金法为主要配伍特征的咳尔康口服液对慢性支气管炎急性发作期具有较好的辅助抗炎和预防复发的效果,方法简单安全,值得在临床上推广应用.

Objective:To observe the effect of Huaier granule combined with chemotherapy on TCM symptoms and life quality in advanced colorectal cancer patients.Methods:60 advanced colorectal cancer patients were randomly divided into two groups.30 patients in the treatment group were treated with Huaier granule and chemotherapy and the controlled group was treated with chemotherapy only.The two groups were both given FOLFOX4 regiment treatment.The changes in their TCM symptoms,KPS,weight and appetite were observed.The following data must be measured before the chemotherapy and 4 courses after it.Results:There was significant difference in their syndrome scores,KPS,weight and appetite(P<0.05).Conclusion:Huaier granule could improve TCM symptoms and life quality indeed.It was effective for advanced colorectal cancer patients.

近年来,随着医疗水平的不断发展和提高,针对各种疾病的药物研究也随之提高,尤其是抗生素类药物,达到了立竿见影的效果,然而再先进的研究都有不完善的地方,抗生素的过量及过度或不合理应用已经产生了很多不良影响,引起了医学界人士的广泛关注。其中,菌群失调位居首位,尤其突出表现在老年患者及体质较弱的患者身上。

目的:观察具有健脾行气作用的枳术散对老年人消化性溃疡的治疗效果.方法:选择消化性溃疡病老年患者(年龄60～80岁)30例,口服中药积术散(白术和枳实按2∶1比例为末)5g,饭前以蜂蜜水送服,每日3次温服.恶食生冷者,以生姜水送服；胃脘疼痛发作频繁者,可于疼痛发作时服药,每次5g,服用次数不限,1个疗程(3周)后,观察患者治疗前后胃镜检查及症状体征改善情况.结果:30例中,痊愈22例,显效5例,有效2例,无效1例,总有效率96.7％.治疗前后主要症状积分变化差异具有统计学意义(P＜0.01).结论:口服枳术散具有显著促进老年人消化性溃疡愈合和明显改善老年人消化性溃疡临床症状的作用.

Objective: To observe the clinical application value of Kuier in the patients with advanced colorectal cancer.Method: 60 cases of advanced colorectal cancer patients were divided into the treatment group and the control group with 30 cases each.The treatment group was with the chemotherapy treatment and Kuier granules,and the control group was with the chemotherapy treatment only.The chemotherapy was with the FOLFOX4 protocols.The changes in T cell subgroup(CD3+,CD4+,CD8+ and CD4+/CD8+),the tumor size,liver and kidney functions,and the other safety indicators before and after the treatment were recorded.Result: Compared with those of the control group,the values of CD8+ in the treatment group were decreased,while CD4+/CD8+ was increased significantly(P<0.05).The differences in the tumor size and adverse reactions were not significant(P>0.05).Conclusion: Kuier granules combined with chemotherapy in the treatment of advanced colorectal cancer can obviously improve the immune function with mild toxicity and high safety,suggesting promising application value in clinics.

OBJECTIVE To observe the effect of Aidi injection combined with chemotherapy on life quality in advanced colorectal cancer patients. METHODS Sixty advanced colorectal cancer patients were randomly divided into two groups.The treatment group with 30 patients were treated with Aidi injection and chemotherapy.The control group with 30 patients were treated with chemotherapy only.The two groups were both given FOLFOX4 regiment treatment.The change in TCM symptoms,KPS,weight and appetite was observed after chemotherapy was given for four courses. RESULTS There were significant differences in syndrome scores,KPS,weight and appetite of the two groups(P0.05). CONCLUSION Aidi injection can indeed improve TCM symptoms and life quality in advanced colorectal cancer patients.

目的:探讨卡维地洛治疗老年人早期心力衰竭(以下称心衰)的疗效。方法:90例经超声心动图测定左心室射血分数(-LVEF)(45%,病情稳定无明显心衰症状和体征的老年患者随机分为治疗组(服卡维地洛),对照组(服安慰剂),经治疗1 a,观察两组病人治疗前后均需超声心动图测定心脏功能等变化。结果:治疗组在静息心率、血压、心脏功能等方面在治疗前后比较有显著差异(P(0.05),治疗效果显著。结论:卡维地洛治疗老年早期心衰可增加心脏射分数,明显改善心脏功能。

左归丸出自《景岳全书》,具有滋阴补肾,填精益髓的功用,临床上可辨证应用于治疗女性更年期综合征、内分泌科疾病、生殖机能异常性疾病、多种骨科劳损性疾病、常见老年性疾病和慢性血液科疾病等多种西医疾病;根据中医脏腑辨证理论,上述西医疾病或和肾藏精功能失调有关,或和肾主生殖作用异常有关,或和肾主骨生髓作用异常有关,且中医辨证总不离肾阴虚损精气亏虚;用药上,可以左归丸辨证配伍益阴柔肝、安神定志之药治疗女性更年期综合征,合用活血通络、行气安神之品治疗常见心脏病,对女性不孕症及月经失调等病的治疗又可以左归丸合用二至丸来调补肝肾,而对于骨科疾病常用左归丸再加补肾强腰壮骨之品,对于痴呆及帕金森等老年病又常需伍入祛瘀通络药。