化肝煎合金铃子散加减治疗胆汁反流性胃炎肝胃郁热证的临床观察

目的 评价化肝煎合金铃子散加减治疗胆汁反流性胃炎（BRG）肝胃郁热证的疗效及对炎症因子和胃肠激素的影响。方法 按随机数字表法将150例患者分为对照组和观察组各75例。对照组脱落、失访5例，剔除2例，完成68例；观察组脱落、失访3例，剔除4例，完成68例。对照组口服达立通颗粒，1袋/次，3次/d，饭前服用。观察组给予化肝煎合金铃子散加减内服，1剂/d。两组疗程均为4周。进行治疗前胃镜检查，评价胆汁反流程度和胃镜下黏膜情况；进行治疗前后肝胃郁热证、慢性胃肠疾病患者报告临床结局（PRO）评价量表、焦虑自评量表（SAS），抑郁自评量表（SDS）评分；进行6个月随访，记录临床复发情况；检测治疗前后胃泌素（GAS），胃动素（MTL），胆囊收缩素（CCK），前列腺素E₂（PGE₂），肿瘤坏死因子-α（TNF-α），白细胞介素-8（IL-8）水平；进行安全性评价。结果 观察组胆汁反流程度评分、胃镜下黏膜评分和肝胃郁热证积分均低于对照组（P<0.01）；观察组PRO量表6个维度（消化不良、反流、排便、社会、心理、全身状态）评分均低于对照组（P<0.01）；观察组SAS和SDS评分均低于对照组（P<0.01）；观察组CCK水平低于对照组（P<0.01），GAS和MTL均高于对照组（P<0.01）；观察组PGE₂水平高于对照组（P<0.01），TNF-α和IL-8水平均低于对照组（P<0.01）；观察组中医证候疗效优于对照组（Z＝2.083，P<0.05）；观察组胃镜疗效优于对照组（Z＝2.104，P<0.05）；观察组临床复发率为20.37%（11/54），低于对照组的40.82%（20/49）（χ2＝5.105，P<0.05）。没有发现服用中药不良反应。结论 化肝煎合金铃子散加减治疗BRG肝胃郁热证患者，可改善临床症状，减轻焦虑、抑郁，提高患者生活质量，改善胆汁反流程度，促进胃黏膜的愈合，并可减轻炎症反应，调节胃肠激素，近期有较好的中医证候疗效和胃镜疗效，远期可降低复发率，且安全。     

Fruit and Vegetable Intake and Stomach Cancer among Male Adults: A Case-Control Study in Northern Viet Nam

Objective: This study investigated the association between fruit and vegetable intake and stomach cancer, with considering the impacts of Helicobacter pylori (H. pylori) infection and tobacco smoking. Methods: A case-control study featuring 80 male incident stomach-cancer cases and 126 male controls was conducted in a general hospital in Viet Nam. A semi-quantitative food frequency and demographic lifestyle questionnaire were used; and venous blood samples were collected to determine H. pylori status by IgG ELISA. The respective associations between fruit and vegetable intake and stomach cancer were examined using unconditional logistic regression analysis with adjustments for possible cofactors. Results: Fruit intake and stomach cancer showed a weak inverse association when this became non-significant after adjusting for H. pylori infection (OR = 0.50, 95%CI: 0.22–1.12, p trend = 0.094). Stratifying by H. pylori status returned a negative trend for fruit intake and stomach cancer among H. pylori-negative participants (OR = 0.21, 95%CI: 0.06–0.69, p trend = 0.010), but no significant interaction for H. pylori-positive participants (OR = 0.76, 95%CI: 0.21–2.68, p trend = 0.670). Vegetable intake and stomach cancer showed no association, regardless of H. pylori status. Compared to ever-smokers with low intake, never-smokers with high vegetable (OR = 0.25, 95% CI: 0.06–0.95) and fruit intake (OR = 0.20, 95%CI: 0.06–0.65) showed the lowest odds of stomach cancer. Conclusions: Fruit, but not vegetable, intake showed a weak inverse association with stomach cancer. H. pylori infection and tobacco-smoking status may influence the protective effects of fruit and vegetable intake on stomach cancer.     

从六经传变理论探“虚不受补”

[目的]从六经传变角度分析"虚不受补"的内在机理,探索完善临床遇见的"虚不受补"问题。[方法]归纳疾病传变如五脏、六经、表里传变的一般规律,总结各类传变的治疗原则,辨析虚实辨证和补法分类,分析产生"虚不受补"的常见现象,提出正确进补的原则与条件。[结果](1)有外感、肺部邪气重,先解表、宣肺,然后才能进补;(2)肠胃有邪气,不可进补,先泄邪气通腑然后可进补;(3)少阳枢机不利则气机不畅,不可进补,先理气转机方可进补;(4)疾病的治疗有表里虚实之辨,也有标本缓急之别,标本之辨在辨证施治时至关重要。[结论]"虚不受补"大多数时候是进补顺序错误导致,在进补前辨别人体的气血状态,对症施药,则可以缓解甚至消除因为进补不当带来的不舒适。解表、健脾胃、活气血、寓消于补是解决虚不受补问题的重要途径。     

黄芪建中汤加减联合针刺治疗消化性溃疡

目的探究黄芪建中汤加减方联合针刺治疗消化性溃疡(脾胃虚寒型)的疗效。方法选取2016年6月-2019年6月本院门诊收治的消化性溃疡(脾胃虚寒型)患者96例作为研究对象,年龄在26~68周岁。根据门诊单双号分为治疗治疗组和对照组,每组48例。对照给予常规口服埃索美拉唑镁肠溶片、阿莫西林胶囊、克拉霉素缓释片、胶体果胶铋胶囊等,治疗组则给予黄芪建中汤加减联合针刺治疗,疗程6周。观察两组患者治疗有效率及不良反应,并采用专业量表调查患者治疗前后中医症候积分、简式McGill疼痛问卷结果。结果两组疗效对比显示,治疗组总有效率明显高于对照组,差异对比有统计学意义(P <0.05);两组患者在中医症候积分、简式McGill疼痛问卷各项积分方面均有显著降低,提示两组均有明显治疗效果。治疗组简式McGill疼痛问卷表中VAS、PPI及PRI(感觉项总分、情感项总分)、差异有统计学意义(P <0.05)。两组不良反应发生情况差异无统计学意义(P> 0.05)。结论黄芪建中汤联合针刺治疗可有效缓解消化性溃疡(脾胃虚寒型)患者中医症候及降低简式McGill疼痛问卷各项积分,疗效可靠,值得临床应用。     

Distribution of the Epstein-Barr virus in the normal stomach and gastric lesions in Thai population

The Epstein-Barr virus (EBV) is one of the infectious agents found in stomach tissue. Recently, EBV-associated gastric carcinoma (EBVaGC) was classified as a new subtype of gastric carcinoma. To date, there is a lack of knowledge about the distribution and prevalence of EBV infection in both the normal stomach and various gastric lesions, including EBVaGC, in the Thai population. In this study, we detected EBV in the normal stomach (NS; n = 19), chronic gastritis (CG; n = 36), intestinal metaplasia (IM; n = 40), gastric dysplasia (GD; n = 15), and gastric adenocarcinoma (GC; n = 33) by polymerase chain reaction (PCR) amplification of the latent membrane protein (LMP1) gene of EBV. EBV-PCR amplification was positive in 42.1%, 36.1%, 22.5%, 13.3%, and 33.3% of NS, CG, IM, GD, and GC, respectively. For further clarification in EBVaGC, we performed EBV-encoded small RNA in situ hybridization (EBER-ISH) in PCR-positive cases of GD and GC. Four GC cases were EBER-ISH positive (12.1%), while both GD cases were EBER-ISH negative. In addition, we determined the distribution of the EBV strain (type A or B) based on EBNA3C sequence and EBV variants based on LMP1 variation (wild-type and 30-bp deletion variants; wt-LMP1 or del-LMP1). The results showed that type A and wt-LMP1 were the most prevalent in all lesions. In conclusion, EBV is common in both the NS and gastric lesions, and the frequency of EBVaGC was 12.1% in Thai patients.     

热敏灸治疗脾胃虚弱型糖尿病胃轻瘫疗效观察

目的:观察热敏灸治疗脾胃虚弱型糖尿病胃轻瘫的疗效及相关机制。方法:将70例脾胃虚弱型糖尿病胃轻瘫患者随机分为对照组和观察组各35例。对照组予多潘立酮片,观察组在此基础上予热敏灸治疗,疗程为1个月。治疗前后测定胃轻瘫症状严重指数量表(GCSI)评分、胃排空率,测定患者静脉血血红素加氧酶-1(HO-1)、胰岛素样生长因子-1(IGF-1)水平,于治疗结束后进行疗效评价。结果:观察组总有效率明显高于对照组(P<0.05);治疗后,两组早饱、恶心呕吐、腹胀评分及GCSI总分明显降低(P<0.05),且观察组低于对照组(P<0.05);治疗后,两组胃排空率均明显提升,观察组胃排空率明显高于对照组(P<0.05);观察组HO-1、IGF-1水平在治疗后明显升高,且与对照组有统计学差异(P<0.05)。结论:热敏灸治疗脾胃虚弱型糖尿病胃轻瘫疗效确切,能显著降低GCSI量表评分,改善胃排空率,这可能与其纠正HO-1、IGF-1水平相关。     

电离辐射致肠道急性损伤的中医病机探讨

电离辐射所致的肠道急性损伤在临床普遍存在,轻者出现纳差、食欲不振、消化不良;重者出现持续的腹痛腹泻,常伴黏液、脓血,肛门坠痛、里急后重,甚至出现梗阻、糜烂、溃疡、穿孔等症。结合电离辐射的中医病因学特点,电离辐射致肠道急性损伤的中医基本病机为:邪盛伤正,气血乏源,虚实夹杂;升降失常,泌别失职,传导失司;“热”“湿”“毒”“瘀”蕴结,损伤血络;屏障缺失,易于恶化。据证立法,方从法出,有的放矢,这不仅为电离辐射导致的肠道急性损伤寻找有效的中医药防治措施提供了理论依据,也进一步拓展了中医药理论的应用范围,因此具有重要的临床价值和实践意义。