目的:探究药物性肝损伤(DILI)的临床特点、致病药物及预后,为临床诊断及治疗提供思路.方法:回顾性分析我院第一诊断为"药物性肝损伤"住院患者的临床资料,将RUCAM评分≥6分的233例患者纳入研究,按服用药物种类将患者分为中药组、西药组、中西药混用组.分析患者性别、年龄、临床表现、临床分型、肝功能指标和预后情况.结果:233例患者中男性115例(49.36％),女性118例(50.64％),平均年龄(45.84±16.16)岁.临床分型肝细胞型125例(53.65％),胆汁淤积型63例(27.04％),混合型45例(19.31％).诱发DILI以抗结核药(14.60％)、抗生素(12.05％)、中成药(10.95％)、中草药(9.13％)、解热镇痛药(8.76％)及胃肠病用药(7.67％)为主.中药组、中西药混用组患者谷草转氨酶(AST)水平高于西药组患者,差异有统计学意义(P<0.05),中药组患者总胆红素(TBil)水平高于西药组、中西药混用组患者,差异有统计学意义(P<0.05).中药组患者碱性磷醇酶(ALP)水平高于西药组患者,差异有统计学意义(P<0.05).233例患者治愈及好转91例,未愈141例,死亡1例.临床分型、ALP水平为影响预后的危险因素.结论:DILI可由多种药物引发,危害不容忽视,临床医生必须加以重视.

早泄是一种自我报告、自我评价其严重程度的疾病.发病率占成年男性的35％～50％[1].长期工作劳累、生活不规律、房事不节等,耗损真气,触犯肾精,致肾气不密,精关不固,发生早泄.金锁二仙饮具有补肾固精两大作用,本研究评价其治疗肾气虚型早泄的临床疗效,报告如下.

目的:以猫吓孕鼠建造"恐伤肾"的肾精不足模型,造模时间为整个妊娠期.方法:孕鼠分娩后,不再惊吓,和仔鼠一起饲养至75日时同时测定母鼠、仔鼠血清中白介素-1(Interleukin-1,IL-1),白介素-2(Interleukin-2,IL-2)的含量.结果:恐吓模型组IL-1,IL-2活性显著高于正常对照组(P<0.05～0.01),滋补肾精方组则低于恐吓模型组(P<0.05).结论:恐伤孕鼠造成肾精不足模型,母子两代IL-1,IL-2的活性升高,中药滋补肾精方对因"恐伤孕鼠"后引起的免疫功能紊乱有调节作用.为通过先天治疗后天的疾病提供了理论依据.

目的:探究乙肝后肝硬化患者肝脏磁共振成像MRI形态学及功能性改变与中医证型的相关性,以期为肝硬化患者中医证候分型及临床辨证治疗提供客观依据.方法:对纳入的164例符合乙肝后肝硬化诊断的患者在进行标准化中医辨证分型后,行MRI常规序列及弥散加权成像(DWI)检查,分析6种乙肝后肝硬化证型的肝左叶、右叶、尾状叶、肝脏长径、左右叶比例失常等形态学改变,并探究DWI功能性成像对证候分型的价值.结果:肝气郁结型右叶横径、矢状径、肝脏长径与其他5型比较,差异均有统计学意义(P＜0.05).肝气郁结型肝左叶横径与脾肾阳虚型、肝肾阴虚型比较,差异有统计学意义(P＜0.05).除肝肾阴虚型肝左叶矢状径与肝气郁结型、湿热蕴结型、瘀血阻络型比较和水湿内阻型肝尾状叶横径与瘀血阻络型比较,差异有统计学意义外(P＜0.05),其他各型尾状叶横径、矢状径、左叶矢状径值比较,差异均无统计学意义(P＞0.05).肝左右叶横径之比、矢状径之比与肝硬化证型进展呈较强的正相关(r=0.45、0.40,P＜0.05),且相比于单个形态学数值对证候辨证分型具有较高的价值.ADC值与肝硬化证型进展呈显著负相关(r=0.81),而且除瘀血阻络型肝脏ADC值与湿热蕴结型及瘀血阻络型与水湿内阻型比较,差异无统计学意义外(P＞0.05),其余各型ADC值比较,差异均有统计学意义(P＜0.05).结论:MRI形态学表现和弥散加权功能成像乙肝后肝硬化证候分型有一定的相关性,能为肝硬化中医证候分型提供的诊断价值.

目的:探究磁共振平扫形态学成像及扩散峰度功能成像(DKI)在乙型肝炎肝硬化中医证候辨证分型中的价值,以期为肝硬化患者精准证候分型提供新的思路.方法:在进行标准化中医辨证分型后,对164例乙型肝炎肝硬化患者行磁共振(MIR)常规序列及扩散峰度成像(DKI)检查.采用单因素方差分析法分析6种证型患者的肝左叶、右叶、尾状叶、肝脏长径、左右叶比例失常形态学改变,并探究DKI功能性成像参数平均扩散系数(MD)、平均峰度(MK)值对中医证候分型的价值.结果:肝气郁结型与其他5型相比,右叶横径、矢状径、肝脏长径差异均有统计学意义(P＜0.05).肝气郁结型与脾肾阳虚、肝肾阴虚型肝左叶横径差异显著(P＜0.05).肝肾阴虚型与肝气郁结、湿热蕴结、瘀血阻络型肝左叶矢状径和水湿内阻与瘀血阻络型的肝尾状叶横径差异具有统计学意义(P＜0.05),其他各型尾状叶横径、矢状径、左叶矢状径值比较差异均无显著意义(P＞0.05).肝左右叶横径之比、矢状径之比与肝硬化证型进展呈较强的正相关(相关系数r分别为0.45、0.40,P＜0.05),且相比与单个形态学数值对证候辨证分型具有较高的价值.MD值随证型进展呈下降趋势(r=-0.85),而且除瘀血阻络型与水湿内阻型、脾肾阳虚型MD值差异不显著外(P＞0.05),其余各型MD值差异均显著(P＜0.05).MK值与证型进展呈正相关(r=0.89),虽然水湿内阻与瘀血阻络型MK值无显著差异外,其余证型MK值差异两两比较均有统计学意义(P＜0.05).结论:MR形态学表现和扩散峰度功能成像与乙型肝炎肝硬化证候证型进展有一定的相关性,能为肝硬化中医症候分型提供较高的诊断价值.

目的:探究磁共振形态学、弥散加权(DWI)及扩散峰度成像(DKI)对乙肝后肝硬化(PHBC)中医证候分型的价值.方法:标准化中医辨证分型后,164例PHBC患者行MR常规序列、DWI及DKI检查,分析比较肝脏形态学改变、DWI表面扩散系数值(ADC)和DKI平均扩散系数(MD)、平均峰度值(MK)对6种中医证候分型的差异.结果:肝左右叶横径之比与PHBC证型进展呈较强的正相关,且对肝硬化中医证型的诊断及鉴别诊断具有较高的价值.MK值与PHBC证型进展呈明显正相关,虽然水湿内阻与瘀血阻络型MK值无显著差异外,但是其余证型MK值比较差异有统计学意义.结论:MR形态学、DWI和DKI成像与PHBC证候证型进展有一定的相关性,能为PHBC中医证候分型提供较高的诊断价值.

水红花子为临床常用药,在汉代就已有记载和使用.本研究通过查阅本草典籍中关于水红花子的记载,对水红花子的名称、来源进行本草考证.结果 表明古代水红花子的原植物荭草与蓼之间关系复杂,直至民国时期仍有争议,导致水红花子与蓼实在临床上经常混用.2015年版中国药典明确了水红花子的基原,而其与蓼实间的差别仍然有待研究.

肺癌发病率、死亡率位居癌症首位,全球每年有近180万新发病例[1-3],我国每年新发73万[4].预计到2025年,我国肺癌患者每年将达到100万,成为世界肺癌大国.肺癌中非小细胞肺癌(non small cell lung cancer, NSCLC)约占85％,其中约70％的患者在诊断明确时已为晚期,失去手术治疗机会[5-7].晚期NSCLC化疗有效率为21.80％～28.10％,中位生存期为11个月[8],可见化疗益处有限.而同步放化疗不良反应较重,但综合介入治疗是一种新模式,疗效显著、安全性高,故本文对NSCLC的综合介入治疗现状作一综述.

血栓闭塞性脉管炎是一种较为特殊的周围血管病变,起病隐匿,发展缓慢,病程较长.目前中医治疗该病遣方用药动辄予以活血化瘀,疗效差强人意.瘀血是否为该病的主要原因尚需进一步探讨.文中从痰瘀论治血栓闭塞性脉管炎,深入探讨该病病机,以期为中医药治疗血栓闭塞性脉管炎提供新的思路.

Hepatocellular carcinoma is one of the most common malignant tumors in China , which is often diagnosed in the middle and advanced stage,when the treatments are very limited.Sorafenib(Nexavar) is a kind of multi-target drug molecule which is the first-line standard treatment for advanced hepatocellular carcinoma,which has been gradually carried out in clinical application and has achieved certain satisfactory clinical efficacy.A large number of clinical randomized trials have proved it can prolong the survival of the patients,bringing benefits to them.

临床资料 患者,女,67岁.因“间歇腹胀5年余,黑便3h”于2015年1月4日入院.查体:慢性肝病面容,腹膨隆,脾肋下3 cm,移动性浊音(+).肝脏血管+三维成像:提示肝硬化、脾肿大、腹水,门脉高压、食管胃底静脉曲张;肝病胆囊,胆囊结石.腹部彩色超声:肝脏弥漫性病变(肝纤维化分期F1 ～F2期),门静脉轻度增宽;胆囊炎症并多发结石;脾肿大,脾静脉轻度增宽.胃镜检查见食管静脉曲张(重度);胃底静脉曲张.血清生化示:总蛋白40.81 g/L,胆碱酯酶1.82 kU/L,三酰甘油0.45 mmol/L.血常规示:WBC 1.27× 109/L,中性粒细胞百分比0.669,淋巴细胞百分比0.181.腹水检查:外观呈乳白色,浑浊,无味,比重1.014,不凝固,黏蛋白试验阳性,蛋白定量15 g/L,RBC 450×106,WBC 80×106,中性粒细胞0.2,淋巴细胞0.8,总蛋白14.44 g/L,碱性磷酸酶21 U/L,谷氨酰转肽酶3.5 U/L,腺苷脱氨酶5 U/L,葡萄糖5.53 mmol/L,乳酸脱氢酶53 U/L.结合患者临床表现及相关辅助检查,诊断为:肝硬化失代偿期(乙型)并门脉高压症,食管胃底静脉曲张,乳糜腹水,脾功能亢进,消化道出血;胆囊结石.

近年来,频繁发生的各种自然灾害不但给社会造成了巨大的经济损失,而且给群众造成了严重的心理障碍,直接影响了灾后重建和经济发展等.因此,灾害创伤后造成的明显心理应激障碍引起了学术界的极大关注,心理干预也日益受到重视.本文就灾害创伤后产生心理应激障碍的发病机制、发病率及影响因素、相关干预措施等研究状况进行综述.

Objective To compare the efficacy of Xelox and Sox neoadjuvant chemotherapies in the treatment of gastric cancer in order to explore a therapy with better clinical outcomes for patients. Methods A total of 86 gastric cancer cases in the Department of Oncological Surgery in First Hospital of Lanzhou University were randomly selected and divided into two groups according to different chemotherapies. And after being treated with 3 periods of neoadjuvant chemotherapies, the Xelox and Sox groups were observed and compared in terms of recent efficacy, tumor stages and radical gastrectomy rates. Prognosis follow-ups were also carried out for efficacy comparison. Results Among the 40 cases of Xelox neoadjuvant chemotherapy, there were 12 cases (30.0%) of RR, 25 cases (62.5%) of radical gastrectomy and 15 cases (37.5%) of non-radical gastrectomy;5 cases (12.5%) were in postoperative phaseⅠ, 3 cases (7.5%) in phaseⅡ,12 cases (30.0%) in phaseⅢ, and 20 cases (50.0%) in phaseⅣ;the overall survival time for the 40 cases was 6-23 months and median survival time was 18 months;time to tumor progression was from 1 to 23 months, with a median value of 15 months. Among the 46 cases of Sox neoadjuvant chemotherapy, there were 27 cases (59.0%) of RR, 38 cases (82.6%) of radical gastrectomy and 8 cases (17.4%) of non-radical gastrectomy;17 cases (37%) were in postoperative phaseⅠ,11 cases (24%) in phaseⅡ, 5 cases (11.0%) in phaseⅢ, and 13 cases (28.0%) in phaseⅣ;the overall survival time for the 46 cases was 8-24 months and median survival time 23 months;time to tumor progression was from 5 to 24 months, with a median value of 20 months. Conclusions Sox neoadjuvant chemotherapy in the treatment of gastric cancer is significantly better than xelox in terms of short-term effect, prognosis and clinical benefits, thus it is preferable for clinical application.

Through the application analysis of the five-element theory in traditional Chinese medicine, to explore the necessity of supplement about the pathogenesis of five elements. Combined with the discussion of the five-element theory stating pathological changes for innovative consummation the theory on pathogenesis of five elements, in order to promote the development of traditional Chinese medicine theory and improve the feasibility to guide clinical work.

肾为机体重要脏腑,素有"先天之本"、"封藏之本"之称.由于肾藏先天之精,主生殖,为人体生命之本源,故称为"先天之本"; 肾藏精,主蛰,又称为"封藏之本"[1].肾藏精主要体现在两个方面,即促进机体的生长、发育和主生殖.根据"肾主生殖"理论,临床上生殖功能障碍所致的不孕、不育等病证,多从补肾填精入手调理治疗.肾主生殖的基本理论,是以肾与生殖器官的联系及生殖功能相关两个方面作为基础的.

肾藏精,包括先天之精和后天之精两个方面:先天之精受于父母,构成胚胎的原始物质,是生长、发育的"先天之本";肾藏精,也包含人体本身具有繁殖后代能力的"生殖之精".肾主藏精是人体生命活动的物质基础,机体的生长发育、生殖及各个脏腑生理功能发挥与维持,无不依赖肾中之"精".但肾虚的本质是什么?如何科学地从微观上客观化、定量化认识其实质,为临床的应用提供可靠的理论依据,是肾虚证及肾虚证模型研究的焦点.现将近年来对肾虚本质的研究进展综述如下.

Objective :To observe the effect of Zibu Shenjing Formula on IGF-1 and IGFBP-3 levels of mice with kidney essence insufficiency,and to explore the mechanism of Zibu Shenjing Formula on nourishing kidney essence.Methods :50 healthy mice were divided into 5 groups :normal group,model group,Jinkui Shenqi Pill group,Zibu Shenjing Formula high-dose and low-dose groups.Except the normal group,other 4 groups were established the animal models of kidney essence insufficiency.From the start,model group was given saline(0.02 mL.g-1),Jinkui Shenqi Pill group was given Jinkui Shenqi Pill(2.7 g.kg-1.d-1),and Zibu Shenjing Formula high-dose and low-dose groups were given different concentrations,that was,Zibu Shenjing Formula(20 g.kg-1.d-1,10 g.kg-1.d-1)respectively for 21 days.Then the general situation of animals,the weights were observed and at the end the quantities of IGF-1 in liver and IGFBP-3 in serum were detected.Results :Zibu Shenjing Formula obviously relieved the symptoms of the mice with kidney essence insufficiency better,improved the weights,the levels of IGF-1 in liver and IGFBP-3 in serum.Conclusion :Zibu Shenjing Formula may play an important role of treating kidney essence insufficiency by methods of regulation of IGF-1 and IGFBP-3.

时吉萍教授治疗月经病提出,因气为血之帅、气行则血行,故调气养血旨在梳理经源；又因肝主疏泄、肝郁则气滞而痛,故疏肝理气重在调经止痛；脾胃乃后天之本、气血化生之源泉,故保护脾胃意在调和冲任；还因肾为一身阴阳之本、又是肝木之母脏,因此平衡阴阳能够帮助月经周期恢复.所以施治时,根据气血盛衰、肝脾肾功能之异常,结合经后、经间、经前、经期的4期具体情况而分别用药.

OBJECTIVE: To investigate the effects of Zibushenjing Fang (formula for tonifying the kidney essence) on skeletal development and brain tissue antioxidation in mice with kidney essence insufficiency.METHODS: Fifty male Kunming mice were randomly divided into five groups: normal group, model group, Jinkuishenqi Wan group, Zibushenjing Fang high dose group, and Zibushenjing Fang low dose group, with 10 mice in each group. The model of kidney essence insufficiency syndrome was established in all the mice except the normal group by using a cat to threaten the mice and by swimming until exhaustion daily which lasted about 21 days. Mice in the model group Were administered 20 mL/kg(-1).d(-1) of normal saline intragastrically. The Jinkuishenqi Wan group was given 2.7 g/kg(-1).d(-1) of a solution of Jinkuishenqi Wan. The Zibushenjing Fang high dose group was given 20 g/kg(-1).d(-1) and the Zibushenjing Fang low dose group was given 10 g/kg(-1).d(-1) of a solution of Zibushenjing Fang. The general condition of all the groups was observed, including the quantity of food and water intake, swimming time, length of femur, and weight of the femur and musculus quadriceps femoris. The total superoxide dismutase (T-SOD), glutathione peroxidase (GSH-Px), and methane dicarboxylic aldehyde (MDA) activities in the brain tissues were detected.RESULTS: Zibushenjing Fang could improve the manifestation of kidney essence insufficiency, increase the quantity of food and water intake, swimming time, femur length, and femur and musculus quadriceps femoris weight. It could also regulate the activities of T-SOD, GSH-Px, and MDA in brain tissue.CONCLUSION: Zibushenjing Fang may play an important role in treating kidney essence insufficiency syndrome by promoting body development and improving brain tissue antioxidation. (C) 2013 JTCM. All rights reserved.

Objective: To observe the effect of Zibu Shenjing Fang on Leptin,Ob-R and NPY level of mice with kidney essence insufficiency,and to explore the each other influence mechanism of spleen and kidney.Methods: 50 healthy male Kunming mouse were divided into 5 groups: normal group,model group,Jinkui Shenqi Wan group,Zibu Shenjing Fang high and low doses group.With established the animal models of kidney essence insufficiency,model group was given saline(0.02mL/g),Jinkui Shenqi Wan group was given Jinkui Shenqi Wan(2.7g·kg-1·d-1),and Zibu Shenjing Fang high-dose and low-dose groups were given Zibu Shenjing Fang(20g·kg-1·d-1,10g·kg-1·d-1) respectively for 21 days.Then observed the general situation of animals,measured the level of Leptin in blood,Ob-R and NPY in Brain tissue.Results: Zibu Shenjing Fang obviously makes the symptoms of the mice with kidney essence insufficiency better,adjusts the activity of Leptin in serum and Ob-R,NPY in Brain tissue(P0.05,P0.01).Conclusion: Zibu Shenjing Fang may play an important role of Filling Kidney essence by adjusting Leptin,Ob-R and NPY,spleen and kidney influence each other is through the Leptin-Ob-R-NPY to realize.