鳖甲煎丸辅助治疗乙肝肝纤维化的疗效及对肝功能和脾肿指数及肝纤维化指标的影响

目的 观察鳖甲煎丸辅助治疗乙肝肝纤维化疗效及对肝功能、脾肿指数及肝纤维化指标的影响.方法 选取2017年5月至2019年5月于本院接受治疗的122例乙肝肝纤维化患者作为研究对象,按照随机数字表法分为观察组与对照组,各61例.对照组给予常规治疗,观察组在对照组基础上联合鳖甲煎丸进行治疗.比较两组治疗前、治疗6个月后肝功能[丙氨酸转氨酶(ALT)、谷草转氨酶(AST)、总胆红素(TBIL)、白蛋白(ALB)]、影像学指标(右肝斜径、门静脉直径、脾肿指数)、肝纤维化指标[透明质酸(HA)、层粘连蛋白(LN)、Ⅲ型前胶原(PCⅢ)、Ⅳ型胶原(Ⅳ-C)]变化,并通过其治疗后的不良反应评估其用药安全性.结果 治疗6个月后,两组患者部分肝功能指标(ALT、AST)、门静脉直径、脾肿指数水平、肝纤维化指标(HA、LN、PCⅢ、Ⅳ-C)水平均显著低于治疗前(P<0.05),且观察组明显低于对照组(P<0.05),而两组TBIL、ALB水平及右肝斜径与治疗前比较差异均无统计学意义.结论 鳖甲煎丸辅助治疗可有效改善乙肝肝纤维化患者肝纤维化程度,促进肝功能恢复,利于病情转归.     

重楼皂苷对肝纤维化大鼠纤维化标志物的影响及其相关性分析

目的:探讨重楼皂苷对四氯化碳(CCl4)诱导的肝纤维化大鼠肝功能以及肝纤维化标志物的影响及其相关性。方法:SD大鼠随机分为正常组、模型组,重楼皂苷低、中、高剂量组,复方鳖甲软肝片组、秋水仙碱组。除正常组外,其余各组采用CCl4致肝纤维化造模。第7周后,正常组灌胃生理盐水,其余各组灌胃相应药物,1次/d。末次给药后,禁食8 h,处死动物取血,ELISA法检测大鼠血清ALT、AST、肝纤四项指标(CⅣ、PCⅢ、LN、HA)含量以及肝组织HYP水平。结果:与模型组比较,重楼皂苷各剂量组大鼠血清ALT、AST和肝纤四项指标含量、肝组织HYP含量降低(P0.05,P0.01)。ALT、AST含量与CⅣ、PCⅢ、LN、HA含量具有相关性(P0.05,P0.01)。结论:重楼皂苷具有一定的保肝降酶作用,能减轻肝纤维化程度。     

田基黄水煎液下调羟脯氨酸和丙二醛对大鼠实验性肝纤维化的保护作用

目的:为提高肝病患者对手术术中肝脏缺氧的耐受及术后肝功能的恢复,观察田基黄水煎液对四氯化碳(CCl4)诱导的实验性肝纤维化的保护作用。方法:将SD大鼠分成正常对照组、模型组、田基黄水煎液低剂量给药组(4 g/kg)和高剂量给药组(8 g/kg),采用CCl4诱导大鼠肝纤维化模型,造模同时给予田基黄水煎液干预,在实验第8周,测定血清肝功相关酶指标[谷丙转氨酶(ALT),谷草转氨酶(AST)]及肝纤维化血清标志物透明质酸(HA),层黏连蛋白(LN)、Ⅳ型胶原(Ⅳ-C)的含量,测定肝组织匀浆中羟脯氨酸(HYP)和丙二醛(MDA)含量。结果:田基黄水煎液不同剂量均能降低肝纤维化大鼠血清ALT、AST、HA、LN和Ⅳ-C含量,同时能减少肝组织中HYP和MDA含量(P<0.05)。结论:田基黄对CCl4诱导的实验性肝纤维化具有防护作用。     

逍遥散对肝纤维化大鼠肝脏保护作用的研究

目的观察逍遥散对胆管结扎致肝纤维化大鼠肝功能及肝纤维化指标的影响。方法采用胆管结扎法复制肝纤维化大鼠病理模型,各组大鼠分别以生理盐水、阳性对照药、低剂量逍遥散、高剂量逍遥散进行干预,测定各组大鼠血清ALT、AST、TBIL、HA、PCIU、LN、Ⅳ—C水平。结果肝纤维化模型组大鼠血清ATJT、AST、TBIL、HA、PCⅢ、LN、Ⅳ—C水平均显著高于假手术组（P〈0．05）;阳性对照药组、逍遥散高剂量组大鼠血清ALT、AST、TBIL、HA、PCⅢ、LN、Ⅳ—C水平均显著低于肝纤维化模型组（P〈0．05）。结论逍遥散对胆管结扎致肝纤维化大鼠肝功能具有一定程度的保护作用,对肝纤维化具有一定的防治作用。     

田基黄水煎液下调羟脯氨酸和丙二醛对大鼠实验性肝纤维化的保护作用

目的：为提高肝病患者对手术术中肝脏缺氧的耐受及术后肝功能的恢复,观察田基黄水煎液对四氯化碳（CCl4）诱导的实验性肝纤维化的保护作用。方法：将SD大鼠分成正常对照组、模型组、田基黄水煎液低剂量给药组（4 g/kg）和高剂量给药组（8 g/kg）,采用CCl4诱导大鼠肝纤维化模型,造模同时给予田基黄水煎液干预,在实验第8周,测定血清肝功相关酶指标[谷丙转氨酶（ALT）,谷草转氨酶（AST）]及肝纤维化血清标志物透明质酸（HA）,层黏连蛋白（LN）、Ⅳ型胶原（Ⅳ-C）的含量,测定肝组织匀浆中羟脯氨酸（HYP）和丙二醛（MDA）含量。结果：田基黄水煎液不同剂量均能降低肝纤维化大鼠血清ALT、AST、HA、LN和Ⅳ-C含量,同时能减少肝组织中HYP和MDA含量（P〈0.05）。结论：田基黄对CCl4诱导的实验性肝纤维化具有防护作用。     

四氯化碳致SD、Wistar大鼠肝纤维化程度的比较

目的比较四氯化碳（CCh）诱导SD和Wistar大鼠慢性肝损伤模型生化改变与肝脏形态特点。方法分别选择SD大鼠（SD组）25只、Wistar大鼠（Wistar组）25只,2组分别皮下注射50％CCl4（0.3mL／100g,用花生油稀释）,每周2次,共8周。给药8周后采集标本。采用全自动生化分析仪检测2组血清丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）的活性及总胆红素（TBIL）、白蛋白（ALB）的含量,放射免疫法检测2组血清透明质酸（HA）、层粘连蛋白（LN）、Ⅲ型前胶原（PⅢ）、Ⅳ型胶原（Ⅳ-C）的含量,常规HE、网状纤维染色检测2组肝组织标本。结果Wistar组血清ALT、AST的活性及TBIL、ALB、HA、LN、PⅢ含量均较SD组高（P〈0.05或P〈0.01）。Wistar组肝脂肪变性较SD组显著增多,但SD组肝纤维化程度较Wistar组更显著。结论CCl4所致肝纤维化程度和肝细胞脂肪变性与动物种属有密切关系。     

仲景三方对大鼠肝纤维化不同时期血清Ⅲ型前胶原、透明质酸及层粘蛋白作用的观察

观察小柴胡汤、大黄虫丸、鳖甲煎丸对不同时期肝纤维化大鼠血清透明质酸(hyaluranic Acid,HA)、层粘蛋白(Laminin,LN)及血清Ⅲ型前胶原(procollagenⅢ,PcⅢ)影响;采用CCl     

鳖甲煎丸对猪血清所致大鼠免疫性肝纤维化的治疗作用

目的：探讨鳖甲煎丸对猪血清所致大鼠免疫性肝纤维化模型是否具有改善作用。方法：腹腔注射猪血清7周制成大鼠免疫性肝纤维化模型后,经口灌胃分别给予鳖甲煎丸3．0、1．5、0．75、0．375g／kg以及阳性药秋水仙碱0．25mg／kg。给药3周后,计算脏器系数;检测大鼠血清中的肝功能指标丙氨酸氨基转移酶（ALT）、天冬氨酸转移酶（AST）、碱性磷酸酶（ALP）、总胆红素（TBIL）、白蛋白（ALB）;检测肝匀浆上清液中肝纤维化指标I型胶原（CoI）、Ⅲ型胶原（Com）、1V型胶原（C0Ⅳ）、Ⅲ型前胶原（PCUI）、透明质酸（HA）、层黏蛋白（LN）;并经Masson染色和HE染色观察不同组别大鼠肝脏的纤维化程度和肝脏细胞的形态。结果：①空白对照组、模型组和给药组动物的体质量和肝脏脏器系数差异均无统计学意义;②鳖甲煎丸的4个剂量组对猪血清致大鼠免疫性肝纤维化模型动物的相应肝功能指标也无明显影响;③3．0g／kg的鳖甲煎丸及0．25mg／kg的秋水仙碱均明显降低了肝匀浆CoI水平（P〈0．05）;0．375、0．75、1．5、3．0g／kg的鳖甲煎丸均不同程度地降低了PCⅢ、HA和LN水平（P〈0．01或0．05）;④Masson以及HE染色结果显示鳖甲煎丸的4个剂量组均不同程度地使肝脏的纤维化组织减少或消失,使大部分肝脏结构恢复正常。结论：鳖甲煎丸对猪血清所致大鼠免疫性肝纤维化具有良好的治疗作用。     

牛樟芝提取物对四氯化碳致大鼠肝纤维化的保护作用

目的探讨牛樟芝提取物对四氯化碳（CCl4）致大鼠肝纤维化（HF）的保护作用。方法将SD雄性大鼠随机分为正常对照组、模型组、牛樟芝提取物低、中、高剂量组和秋水仙碱组,采用CCl4诱导和高脂饲料喂养构建HF模型,造模同时分别予不同浓度的牛樟芝提取物和秋水仙碱进行干预,连续8周。观察大鼠一般情况和体质量,计算各组大鼠的肝系数,检测血清肝功能指标中谷丙转氨酶（ALT）、谷草转氨酶（AST）、总胆红素（TB）、乳酸脱氢酶（LDH）和肝纤维四项指标中血清透明质酸（HA）、层粘连蛋白（LN）、Ⅲ型前胶原（PC-Ⅲ）、Ⅳ型胶原（ColⅣ）含量,Western blot法检测肝脏TGF-β1蛋白表达,采用HE染色、Masson染色法进行肝脏病理学观察。结果与模型组比较,牛樟芝提取物中、高剂量组大鼠血清ALT、AST、TB、LDH、HA、LN、PC-Ⅲ、ColⅣ含量均显著下降（P<0.05,P<0.01）,TGF-β1蛋白表达明显降低;肝组织胶原纤维明显减少,肝纤维化及肝脏损伤程度减轻。结论牛樟芝提取物对CCl4所致大鼠纤维化具有明显的保护作用,其机制可能与减轻肝细胞变性和纤维化,抑制相关炎症因子的释放有关。     

鳖甲消癥丸抗大鼠肝纤维化的实验研究

目的研究鳖甲消癥丸对大鼠肝纤维化的防治作用.方法运用皮下多次注射四氯化碳致大鼠慢性损伤性肝纤维化模型,观察不同剂量鳖甲消癥丸对大鼠肝组织病理变化、血清透明质酸、血清丙氨酸氨基转移酶(ALT/GPT)、天冬氨酸氨基转氨酶(AST/GOT)、总蛋白(TP)和白蛋白(Alb)以及内脏器官重量和门脉压的影响,并与秋水仙碱进行了比较.结果各剂量组的鳖甲消癥丸均对大鼠肝脏有一定的保护作用,且预防效果比秋水仙碱组好,但组间差异不明显.结论鳖甲消癥丸可有效预防四氯化碳所致的大鼠肝纤维化作用.     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.