最新刊期
期 10 ， 2018
- 摘要：<正>2018年8月4日,第十三届全国幽门螺杆菌及消化疾病诊治临床论坛在北京胜利召开,会议正式发布了由北京医学会、中华中医药学会脾胃病分会、世界中医药学会联合会消化病专业委员会、中国中西医结合学会消化病专业委员会、中国幽门螺杆菌信息中心等单位共同组织制定的首部《全国中西医整合治疗幽门螺杆菌相关"病-证"共识》[1]（以下简称《共识》）。《共识》指出了当前我国幽门螺杆菌治疗所面临的巨大挑战,关键词：幽门螺杆菌;整合医学;病证结合;共识
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发布时间：2023-04-10 - 摘要：目的分析中药为主非抗生素疗法治疗幽门螺杆菌（HP）感染的效果。方法将2013年10月—2016年2月就诊于北京大学第一医院中医中西医结合科的78例HP感染患者分为A组48例、B组19例、C组11例,A组给予荆花胃康胶丸联合益生菌复合乳酸菌胶囊口服,B组给予荆花胃康胶丸口服,C组给予荆花胃康胶丸联合中药复方煎汤剂口服,疗程均为4周。观察各组治疗前后中医症状积分变化,统计治疗期间发生的不良反应、HP根除率,记录DOB值。结果与治疗前比较,治疗后3种疗法中医症状积分均降低（P <0. 05）,其中荆花胃康胶丸联合煎汤剂降低最明显（P <0. 05）。患者治疗期间均未发生明显的不良反应,且依从性良好。78例患者HP转阴25例,根除率32. 1%。A组转阴16例,根除率30. 0%; B组转阴5例,根除率26. 3%; C组转阴4例,根除率36. 3%。53例未转阴患者,3例DOB值较治疗前增高,其余50例DOB值均较治疗前下降。结论中药为主非抗生素疗法可改善HP感染患者的症状,但HP的根除率有限。关键词：幽门螺杆菌;非抗生素治疗;荆花胃康胶丸;益生菌;中药
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发布时间：2023-04-10 - 摘要：目的观察六君子汤加减治疗HP根除后慢性萎缩性胃炎伴肠上皮化生的效果。方法 HP根除后慢性萎缩性胃炎伴肠上皮化生患者34例,均为脾胃虚弱型,均给予六君子加减方加减治疗6个月,评价患者临床症状、胃黏膜病理改善情况及安全性。结果与治疗前比较,治疗3个月患者胃脘胀满、胃脘疼痛、乏力、气短、食少纳呆、胃中嘈杂、嗳气反酸、口干口苦、恶心呕吐的积分及总分降低（P <0. 017）,治疗6个月时大便溏稀积分降低（P <0. 017）;胃黏膜萎缩、肠上皮化生及病理总积分下降（P <0. 05）。临床症状总有效率97. 1%,肠上皮化生总有效率为58. 1%。完成内镜复查的31例患者均未复发,且生命体征、肝功能、肾功能均未出现异常。结论六君子加减方能明显缓解HP根除后慢性萎缩性胃炎伴肠上皮化生患者的临床症状,改善胃黏膜病理变化,且安全性高。关键词：慢性萎缩性胃炎;六君子加减方;幽门螺杆菌;肠上皮化生
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发布时间：2023-04-10 - 摘要：目的从舌象变化探讨HP感染慢性萎缩性胃炎的病机演变。方法采用前瞻性单臂临床观察性研究设计,收集102例经内镜结合病理学检查及尿素13C呼气试验确诊慢性萎缩性胃炎HP感染的患者,四联疗法对根除HP治疗前后患者的舌象变化进行比较。结果慢性萎缩性胃炎HP感染根除治疗前后患者的舌质变化差异无统计学意义（P> 0. 05）;舌苔变化差异有统计学意义（P <0. 05）。HP感染根除治疗前舌苔以黄腻苔为主; HP感染根除治疗后舌苔以薄白苔为主。结论慢性萎缩性胃炎HP感染根除治疗前后舌苔变化有差异,HP感染根除治疗前舌苔以黄腻苔为主,苔黄腻多为湿热,病邪性质以"湿""热"为主,表现为实证、热证。HP感染治疗后舌苔以薄白苔为主,表现为虚证、寒证。舌象变化的客观性提示HP感染慢性萎缩性胃炎的病机为本虚标实,虚实夹杂,初期以邪实为主,后期以正虚为主。关键词：舌象;慢性萎缩性胃炎;HP;病机
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发布时间：2023-04-10 - 摘要：目的探讨HP根除治疗与舌象变化的相关性。方法在查阅文献,综合相关专家意见的基础上,设计舌象调查表,采集129例HP阳性患者的舌象信息,录入"HP感染中西医结合临床数据库",进行数据分析。结果 129例经HP根除治疗并复查为阴性的患者治疗前后舌色分布差异有统计学意义（P <0. 05）,治疗后红舌（鲜红舌+暗红舌+绛红舌）所占比例明显下降,淡红舌所占比例上升;治疗前后不同种类舌苔分布差异有统计学意义（P <0. 05）;舌苔黄者所占比例降低,舌苔白者所占比例升高,治疗前后苔色比较差异有统计学意义（P <0. 05）;而治疗前后苔质腻与不腻差异无统计学意义（P> 0. 05）。结论 HP根除治疗后舌象变化显著,根除治疗后红舌、黄苔所占比例降低。关键词：门螺杆菌感染;舌象;治疗;相关性
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发布时间：2023-04-10 - 摘要：Objective To study the bacteriostasis of Chenopodium ambrosioides L. against HP metronidazole resistant and susceptible strains in vitro. Methods The minimal inhibitory concentrations （MIC） of Chenopodium ambrosioides L. against HP were selected,agar dilution method used to observe the effect of the drug on the growth of HP under different drug concentrations and different action times,with HP metronidazole resistant strain （26695-16R,26695-8 R16S,26695-2 R8S） and susceptible strains （NCTC 11637,26695）setting as the experimental strains. Results Chenopodium ambrosioides L. was active against HP metronidazole resistant and susceptible strains under different action times （MIC value 4 ～ 256 μg/m L）,and the differences of MIC values decreased with the prolongation of drug action time. Conclusion Chenopodium ambrosioides L. had bacteriostasis to HP metronidazole resistant and susceptible strains. The antibacterial effect was positively related with the drug concentrations and the effect tended to be stable after 72 h.关键词：helicobacter pylori;Chenopodium ambrosioides L.;antibacterial activity
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发布时间：2023-04-10 - 摘要：Objective To observe the changes of intestinal flora structure and abundance in mice with gastritis induced by Helicobacter pylori （HP）. The cecal contents were obtained for sequencing analysis,and the effects of long-term use of the extract of Chenopodium ambrosioides L. on mice were investigated by analyzing the changes in the structure of the intestinal flora. Methods Thirty male Kunming mice were randomly divided into blank group （n = 10）,model group （n = 10） and CAL （Chenopodium ambrosioides L.）group （n = 10）. After HP infection was established,they were administered drugs for 4 weeks,and fresh rectal stools of each group of mice were taken at the same time. The 16 S rDNA-V3-V4 region of the fecal samples was sequenced on an Illumina Hi Seq PE250 highthroughput sequencing platform to quantify the structure and abundance of the intestinal flora. Results At the level of the portal,the relative abundance of the Helicobacter pylori infection model group,such as Bacteroides, Proteobacteria, Mycobacterium, Softwalled bacteria,and actinomycetes,were decreased,and the relative abundance of the thick-walled bacteria increased in the model group. There were significant differences with the blank group and the schizonepeta group; at the genus level,the relative abundance of the model group Lactobacillus and Bifidobacterium decreased, Bacteroides, rumen cocci, dystrophic and Phytophthora,Enterococcus,increased. The relative abundance of the genus Monocytogenes was elevated. The relative abundance of Enterobacter and Limerella was increased,and the relative abundance of Enterococcus was decreased. Conclusion This study suggests that colonization of HP significantly could change the structure of the intestinal flora,and the abundance and diversity of the intestinal flora could be reduced. The pathogenesis of HP infection with gastritis may be related to the decrease of probiotics and the increase of harmful flora. Intervention of E. striata can improve the effect of HP infection on intestinal flora and increase the diversity of flora.关键词：Chenopodium ambrosioides L.;intestinal flora;helicobacter pylori;gastritis;high-throughput sequencing
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发布时间：2023-04-10 - 摘要：HP与湿热病邪之间存在密切联系,湿热所产生的局部微生态环境有利于HP的定居、生长和繁殖。诸多实验和临床研究都表明脾胃湿热的环境下HP感染率较高。临床诊断HP感染要注重结合脾胃湿热证的舌苔,尽可能有针对性地加以初步筛查,治疗HP感染要注重调节和改善脾胃湿热证患者的体质,尽可能从根本上改变HP的生存环境,这为诊断、治疗和预防HP感染提供了新的思路。关键词：幽门螺杆菌;脾胃湿热证;相关性
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发布时间：2023-04-10 - 摘要：幽门螺杆菌是胃内一种感染性致病菌,与多种胃肠道疾病密切相关,而西医根除治疗目前遇到诸多瓶颈。从现代医学关于幽门螺杆菌黏附机制的研究成果入手,结合中医对于幽门螺杆菌感染的认识,探讨治疗幽门螺杆菌感染的新方法、新手段。认为在幽门螺杆菌感染中,"湿热"为始动因素,应重视"脾胃湿热"病机,关注幽门螺杆菌黏附阶段,及时阻断其进一步感染;提出幽门螺杆菌感染的中西医结合、"病-证-体-方"四位一体、"治未病"阶段用药预防策略,为中医药以及中西医结合治疗幽门螺杆菌感染提供新的思路。关键词：幽门螺杆菌;黏附;湿热证;治未病
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发布时间：2023-04-10 - 摘要：Objective To analyze the current situation and existing problems of the control type of randomized controlled trials （RCTs） and provide references and suggestions for improving the efficacy evaluation of RCTs. Methods The RCTs on Chinese herbal medicine for type 2 diabetes mellitus in China National Knowledge Internet,VIP database,Wanfang database,Sinomed,Pubmed and CENTRAL were searched from establishment of database to June 2017, and classified and evaluated properly according to control setting principle of clinical epidemiology. Results A total of 2046 RCTs published from 1986 to 2017 were included,including 2030 in Chinese and 16 in English. In this study, only 68 （3. 32 %） RCTs used placebo control. Glucoselowering western medicine and insulin were the main controls used by RCTs （1700,83. 09 %）, and the proportion increased with years. The proportion of Chinese herbal medicine as control was the second （207,10. 12 %）,but decreased during the last10 years. Conclusion Due to lack of high quality evidence in most of the Chinese herbal medicine at present, it may be unreasonable for Chinese herbal medicine as a control to prove the effect of interventions,and placebo-controlled trials should be added based on the conventional treatments.关键词：control;randomized controlled trials;Chinese herbal medicine;Type 2 diabetes mellitus
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发布时间：2023-04-10 - 摘要：Objective To explore the application of QOL scale in the clinical research of pediatric eczema and the problems. Methods The literatures about application of QOL scale in the clinical research of pediatric eczema in China and abroad were reviewed and the present status were analyzed. Results The utilization of QOL in China was still in learning period,and meanwhile the content of selfdesigned scales only involved infants’ dermatitis quality of life index （IDQo L）. The research of QOL scale in other countries was at the exploratory stage. Its reliability and validity need further to be checked and tested. But the open access to the database and website can make it possible for further study. Conclusion The specific QOL scale for pediatric eczema should combine with the advantages of other scales based on the existing scale,and take the reliability and validity into account to make it reasonable,effective and practical.关键词：Quality of life （QOL） scale;eczema;children
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发布时间：2023-04-10 - 摘要：Objective Objective To know the effect of acupuncture for cancer patients ’ quality of life and the quality of related literatures. Methods The randomized controlled trials （RCTs） studies involving the effect of acupuncture for cancer patients’ quality of life,related complications with scores of quality of life as the onset criteria published from January 2012 to October 2017 were searched on CNKI,WANFANG and VIP databases. Cochrane Risk of Bias Criteria and STRICTA Criteria were used to assess the quality of trials. Results 32 RCTs were included,involving 1878 patients. A majority of the included trials were of moderate to high risk of bias in methodological quality,and the quality of evidence was low. Due to the large heterogeneity among the studies,the outcome data could not be pooled quantitatively. 68. 75% of trials reported that acupuncture could improve the cancer patients’ quality of life,but 9. 38%trials didn’t support this viewpoint. There were still many problems in the quality of the methodology and acupuncture intervention in this field,such as imperfection and inaccuracy. Conclusion The Results show that acupuncture can improve the quality of life of cancer patients to a certain extent. But because of the low quality evidences of studies and small sample size,the credibility is not high. High quality,multi-centered prospective RCTs with bigger sample size are needed to certify the effect of acupuncture.关键词：cancer;acupuncture;quality of life;scale;randomized controlled trial
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发布时间：2023-04-10 - 摘要：Objective To investigate the effect of Liqi Jianpi Formula-invigorating spleen qi on esophageal and gastric varices bleeding （EGVB） in patients with cirrhosis. Methods A total of 427 cases of patients with liver cirrhosis accompanied by esophageal gastric varices,who flowed the inclusion criteria,were collected from January 2010 to July 2016 in Beijing Ditan Hospital affiliated to the Capital Medical University,and they were followed up for 1 year. According to the fact whether EGVB occurred or not,they were divided into bleeding group and non-bleeding group,Logistic regression method was used to analyze the independent risk factors for the happening of EGVB,and the prevention effect of the formula on EGVB observed. Results Whether Liqi Jianpi Formula was taken or not is one of the independent risk factors of EGVB for patients with cirrhosis within one year. Of the two groups by 1∶1 propensity score matching,EGVB in Liqi Jianpi Formula group accounted for 21. 9%,in control group 48. 5%,and EGVB was reduced by 26. 6% in Liqi Jianpi Forumla group compared with that of the control group,and difference was statistically significant （P = 0. 002）; for the time from follow-up to EGVB,Liqi Jianpi Forumla group was（8. 4 ± 0. 3） months,the control group was（5. 3 ± 0. 2） months,the two groups had statistical difference （P < 0. 01）. Conclusion Liqi Jianpi Formula can reduce the incidence of EGVB within 1 year in patients with cirrhosis,extend time in liver cirrhosis patients with esophageal gastric varices with no bleeding.关键词：cirrhosis;esophageal and gastric varices bleeding;Liqi Jianpi Formula;TCM therapy
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发布时间：2023-04-10 - 摘要：张炳厚教授认为耳鸣耳聋常见于肝火旺盛、风阳上扰;肾精亏虚、耳窍失养;脾胃虚弱,清阳不升3种病因。临床辨证时,强调以脏腑辨证为基础,从肝、肾、脾三脏入手,根据新病久病、耳鸣声音强弱和其他伴随症状分清阴阳虚实。张教授将耳鸣分为肝火、肾虚、脾虚三证,治疗各有专方。常用方剂有滋阴潜阳、平肝熄风的滋生青阳汤,补气养血、培元固本的大补元煎,健脾益气、升阳通窍的益气聪明汤,在此基础上灵活加减,阳亢火旺者加潜镇降逆药,耳窍郁闭者加芳香开窍药,疗效颇佳。关键词：张炳厚;耳鸣;经验;中医辨证
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发布时间：2023-04-10 - 摘要：王家骥老师认为眩晕为虚实夹杂之症,病因病机上主要与"风、痰、瘀、虚"等因素密切相关。其中"风、痰、瘀"为外因,而"虚"为内因,内外因通常共同存在,相互影响。在辨证分型上,王老将眩晕分为痰浊内蕴、肝肾不足、气滞血瘀、气血不足等证型。临证治疗常以补虚泻实,调整阴阳为原则,分别给予燥湿祛痰、滋补肝肾、行气活血、补气健脾等方法。强调补肝肾,祛风痰,行气血。用药上王老注重使用平和之品,治中寓补,补虚纠偏。同时重视对患者的心理调节,以宽慰之言缓解其焦虑情绪,解除思想顾虑,临床收效颇佳。关键词：眩晕;王家骥;辨证论治;名中医经验
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发布时间：2023-04-10 - 摘要："脏腑风湿""顶焦"是仝小林教授基于经典及多年临床经验总结创新的概念。基于某些顶焦疾病的起病特点,或发病前存在呼吸道感染,或反复感染（细菌、病毒或朊病毒等）,或由免疫介导引起,仝教授从脏腑风湿理论出发提出"顶焦风湿病",并指出外邪侵袭是必要外因,邪气伏留是致病关键,脏腑内虚是重要基础。治疗以驱邪外出为首要治则,基于顶焦多髓海空虚的生理特点,治疗在驱邪外出的同时不忘扶正,三生饮、通窍活血汤、身痛逐瘀汤、小续命汤、阳和汤是治疗顶焦疾病驱邪外出的常用方剂,麻黄是仝小林教授治疗顶焦疾病的靶药;同时不忘补肾纳精充髓,方药可选地黄饮子、仝氏通脊益髓丹等。关键词：脏腑风湿;顶焦;神经系统;仝小林
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发布时间：2023-04-10 - 摘要：《卫生家宝产科备要》八卷,南宋朱端章编辑,徐安国整理,简称《产科备要》,又名《卫生家宝产科方》,初刊于南宋淳熙十一年（1184年）。通过运用对比的研究方法,对该书引书进行了详细考证,可知本书不但保存了一些传世文献的内容,例如《千金方》《幼幼新书》等,而且保存了很多未见流传的古籍内容,例如《备产济用方》《胎产经验方》等,对于研究当时的中医古籍具有一定的文献价值。关键词：卫生家宝产科备要;版本;引书;考证
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发布时间：2023-04-10 - 摘要：临床运用《伤寒论》经方辨治血管神经性头痛,表虚邪郁型用桂枝麻黄各半汤以解表散邪,小发其汗,而邪去病除;寒滞经络型用葛根汤以通经活络、调理气血;血热夹瘀型用桃核承气汤以通瘀于泄热之中,逐邪于行血之际;胃虚痰阻型用旋覆代赭汤以使脾胃之气得健,痰饮之邪得除,肝胃气逆得平;寒邪痹阻型用麻黄细辛附子汤以温经通阳,通络止痛;肝郁气滞型头痛用四逆散以疏肝理气,通阳解郁;阳虚火郁型用乌梅丸以寒热并用,清上温下;肝胃虚寒型用吴茱萸汤以暖肝胃,降浊阴。随证而施,灵活加减。关键词：血管神经性头痛;中医药疗法;经方;伤寒论
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发布时间：2023-04-10 - 摘要：运用六经辨证理论治疗女性寻常痤疮时,从患者症状表现入手,先辨六经再辨方证。从胡氏六经辨证角度辨治女性寻常痤疮,口干、口渴,面部油腻,从阳明加湿论治,方选麻黄连翘赤小豆汤加减;口苦、咽干,心烦易怒,从少阳阳明夹瘀论治,方选小柴胡加石膏汤加减;四逆、畏寒、腹胀,从厥阴太阴论治,方选薏苡附子败酱散加减,临证注意抓主证,辨兼证。关键词：女性;寻常痤疮;胡希恕;六经辨证
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发布时间：2023-04-10 - 摘要：目的观察胫腓骨骨折患者接受闭合复位带锁髓内钉内固定术后,早中期应用经验方治疗促进骨折愈合的疗效。方法收治闭合性胫腓骨骨折的住院患者69例,随机分为入组接骨丹组（试验组） 33例,接骨七厘胶囊组（对照组） 36例,均行闭合复位带锁髓内钉内固定术,术后给予相应药物口服,连续观察12周。观察2组的肢体疼痛、肿胀、影像学指标和Johner-wruh胫骨干骨折疗效。结果术后2周,试验组的疼痛、肿胀评分均较对照组改善明显（P <0. 05）。第12周,试验组X线片骨痂灰度值高于对照组（P <0. 05）。2组患者骨折疗效评价优良率均满意。结论试验组术后第12周时骨折端的骨质厚度高于对照组,接骨丹可以促进骨折早中期愈合。关键词：接骨丹;胫腓骨;骨折愈合;早中期;临床研究
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- 61
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发布时间：2023-04-10 - 摘要：目的观察桂枝茯苓胶囊联合孕三烯酮、米非司酮治疗子宫内膜异位症的临床效果。方法子宫内膜异位症患者105例,根据实际治疗方法分为对照组50例、观察组55例。对照组给予米非司酮、孕三烯酮连续治疗3个月;观察组在对照组治疗基础上加服桂枝茯苓胶囊,连续治疗3个月。观察2组治疗前后症状、体征评分及异位囊肿包块直径、激素、炎症因子、VEGF、Leptin水平。结果 2组治疗后盆腔症状评分、体征评分、异位囊肿包块直径、激素、炎症因子及血清VEGF、Leptin水平均较治疗前改善（P <0. 05）,且观察组改善程度优于对照组（P <0. 05）。结论桂枝茯苓胶囊联合孕三烯酮、米非司酮效果优于单纯孕三烯酮联合米非司酮治疗。关键词：子宫内膜异位症;桂枝茯苓胶囊;孕三烯酮;米非司酮
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- 70
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发布时间：2023-04-10 - 摘要：目的观察以中医理论为指导的穴位按摩疗法对非小细胞肺癌术后化疗消化道反应的改善作用。方法将154例非小细胞肺癌术后化疗患者采用随机数字表法分为观察组和对照组,各77例。2组均给予住院常规治疗及护理,观察组在此基础上给予穴位按摩治疗。治疗5天后比较2组的消化道反应评分。结果观察组治疗后消化道反应评分均低于对照组,差异具有统计学意义（P <0. 05）。结论穴位按摩疗法对非小细胞肺癌术后化疗消化道反应的改善具有正向作用。关键词：穴位按摩疗法;消化道反应;临床观察
- 2
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- 93
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发布时间：2023-04-10 - 摘要：目的分析中药注射剂不良反应/事件发生的原因与临床不合理用药之间的关系,总结相关应对措施,促进临床安全、合理地使用中药注射剂。方法回顾性分析913例中药注射剂不良反应/事件报告表并对中药注射剂的用法用量是否适宜进行点评,并对医护人员开展"对合理使用中药注射剂掌握情况"的问卷调查。结果 913例报告中,涉及中药注射剂38种;发生不良反应的女性患者所占比例（61. 45%）高于男性患者（38. 55%）,发生不良反应/事件的患者年龄51～80岁的中老年患者占68. 35%; 913例报告表中,记录详细的356例中,有183例未按照说明书用法用量使用,属于不良事件（ADE）;其余173例按照说明书用法用量使用,属于不良反应（ADR）。结论不良反应/事件的发生不仅与注射剂本身因素、患者自身因素相关,更与临床不合理用药密切相关,医护人员应加强对中药注射剂合理使用的学习,是促进中药注射剂安全、规范、合理使用的关键。关键词：中药注射剂;不良反应/事件;原因分析;临床不合理用药;应对措施
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- 255
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发布时间：2023-04-10 - 摘要：半夏泻心汤临床常用单味药剂量低于张仲景经方中记载;为保障临床用药安全,现方中君药半夏较少使用生品,多根据患者病因病机和各炮制品功效及主治,使用法半夏、姜半夏、清半夏。当今临床处方药物剂量、组方规律在各种因素的作用下,已与经方产生差异,可通过医药结合的临床中药学思维,探讨经方组方法度和现代中药药理,使经方得到合理应用。关键词：半夏泻心汤;单味药剂量;炮制;中药学思维
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- 301
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- 1
发布时间：2023-04-10 - 摘要：目的通过对服用补骨脂及其制剂导致肝损害的病例进行回顾性分析,探讨补骨脂及其制剂导致肝损害的特点。方法收集1987—2017年间在中国学术期刊全文数据库（CNKI）、万方数据库和外文数据库（PubMed）发表的补骨脂及其制剂导致肝损害相关文献,并进行分析。结果共收集到13例补骨脂及其制剂致肝损害的病例,其特点主要为服药时间长、常规及超量均可导致肝损害。结论服用补骨脂期间应按疗程服用同时加强肝功能监测。关键词：补骨脂;肝损害;剂量;转归
- 2
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- 212
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发布时间：2023-04-10 - 摘要：<正>慢性肾脏病（chronic kidney disease,CKD）是我国高发疾病,截至2012年统计结果显示,我国成人慢性肾脏病患病率已达到10. 8%[1],国内外肾脏病科医师均在不断寻求和完善慢性肾脏病一体化治疗的最佳方案。临床实践及研究证明,中医药治疗慢性肾脏病具有一定的优势。1理论依据中医外治法是一种通过多途径给药,以刺激经络、穴位、皮肤、黏膜、肌肉、筋骨,使药物关键词：慢性肾脏病;中医外治法;研究进展
- 2
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- 433
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发布时间：2023-04-10
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