Dupilumab for Treatment of Food-Dependent, Exercise-Induced Anaphylaxis: Report of One Case

Food-dependent,exercise-induced anaphylaxis(FDEIA)is a potentially life-threatening disorder that often occurs with exercise,and patients typically have eaten a specific food within hours before disease onset.This disease is exceedingly rare,with a prevalence of 0.02%.No well-recognized prevention or treatment strategy has been available for FDEIA except avoiding triggers strictly.Here we report an 11-year-old boy with a history of recurrent anaphylaxis of unknown etiology more than 10 times within two years.As the anaphylactic symptoms had not been controlled after traditional treatments,the patient was given subcutaneous injection of dupilumab seven times within 33 weeks.During dupilumab treatments,the patient was exposed to culprit mushrooms plus exercises at least twice a month but without notable anaphylaxis.Thus,dupilumab may improve the allergic reactions in FDEIA patients.

Variations in Inflammatory Cells and IL-6 in Long-Distance Runners Susceptible to Exercise-Induced Bronchospasm and Previously Treated with Salbutamol

Background: Exercise-Induced Bronchospasm (EIB) is an inflammatory condition characterized by severe airway constriction following the mobilization of inflammatory cells and interleukin-6 (IL-6). When severe, EIB can require the use of pressurized salbutamol to treat athletes. This study investigated the nature of the systemic changes in inflammatory cells and post-exercise IL-6 concentrations after salbutamol treatment in EIB-susceptible distance runners. Materials and Methods: This was an experimental study that enrolled 12 long-distance runners. In Session A, the participants completed a treadmill exercise test, and those who had a maximum expiratory volume per second (FEV1) that was decreased by at least 10% compared to their base value were placed in the EIB-susceptible group (EIB+) (n = 6). Those whose FEV1 did not meet this criterion were placed in the nonresponsive (EIB?) group (n = 6). Before the Session B exercise, athletes in the BIE+ group inhaled two puffs of salbutamol (EIB+ Salb), while their EIB? counterparts received no treatment. Spirometry was performed before and after the exercise using a Spirobank G portable spirometer. Blood samples were taken before, immediately after and 2 hours after the stress test. Results: The mean post-exercise FEV1 values were not significantly different (p > 0.05) between the EIB+ Salb group and the EIB? group. The systemic changes in inflammatory cells and IL-6 concentrations in the EIB+ runners after salbutamol treatment were similar to those observed in their EIB? counterparts. Conclusion: Salbutamol pretreatment improved the systemic immune status of EIB-susceptible athletes.

Study on Mechanism of Dendrobium officinale Kimura et Migo in Preventing and Treating Exercise-induced Muscle Damage(EIMD)in Rats

[Objectives]This study was conducted to observe the mechanism of Dendrobium officinale Kimura et Migo on gastrocnemius muscle in rats with exercise-induced muscle damage(EIMD).[Methods]The micro-injury model of skeletal muscle was established by treadmill training.Forty two SD rats were randomly divided into a control group,1,12 and 24 h exercise groups,D.officinale 2 ml+1 h exercise group,D.officinale 2 ml+12 h exercise group,and D.officinale 2 ml+24 h exercise group,with 6 rats in each group.Various D.officinale groups were given the drug once in the morning and once in the evening at a dose of 2 ml/time,a week in advance.Except for the quiet group,the samples were collected from the 1,12 and 24 h exercise groups after anesthesia following 1,12 and 24 h of exercise for the last time,respectively,and the D.officinale 2 ml+1 h exercise group,D.officinale 2 ml+12 h exercise group and D.officinale 2 ml+24 h exercise group were also sampled after anesthesia following 1,12 and 24 h of exercise for the last time,respectively.The contents of ATP,CK-MM and CK in rat serum were determined by enzyme-linked immunosorbent assay(ELISA).The histopathological changes of gastrocnemius muscle were observed by HE staining.PCR and Western-blot detection were carried out to analyze the effects of D.officinale on IGF-1 mRNA and protein expression in gastrocnemius muscle.[Results]Compared with the quiet group,the ATP contents in the serum of rats in the 1,12 and 24 h exercise groups significantly decreased(P<0.01),while the CK and CK-MM contents significantly increased(P<0.01).The expression of IGF-1 mRNA and protein in the gastrocnemius muscle tissue significantly increased(P<0.01).Compared with the 1 h exercise group,the ATP content and IGF-1 protein expression in the gastrocnemius muscle tissue of the D.officinale liquid+1 h exercise group significantly increased(P<0.05),while the CK and CK-MM contents significantly decreased(P<0.01).Compared with the 12 h exercise group,the D.officinale liquid+12 h exercise group showed a significant increase in ATP content(P<0.01),significant increases in IGF-1 mRNA and protein expression in the gastrocnemius muscle tissue(P<0.01),and significant decreases in CK and CK-MM contents(P<0.01).Compared with the 24 h exercise group,the ATP content and IGF-1 mRNA and protein expression in the gastrocnemius muscle tissue of the D.officinale liquid+24 h exercise group significantly increased(P<0.01),while the CK and CK-MM contents significantly decreased(P<0.01).From the pathological tissue morphology of the gastrocnemius muscle in rats with EIMD treated with D.officinale,it could be concluded that the gastrocnemius muscle of each exercise group was significantly damaged,and the damage was significantly alleviated after administration of D.officinale liquid.[Conclusions]The effects and mechanism of D.officinale on prevention and treatment of EIMD in rats might be related to the promotion of IGF-1 mRNA and protein expression in injured tissues by reducing ATP energy consumption,CK-MM and CK activity.

Hematuria after nocturnal exercise of a man: A case report

BACKGROUND A man experienced multiple episodes of macroscopic hematuria following nocturnal exercise.Urinary stones and tumors were considered the two most likely causes.The patient had two hobbies:Consuming health care products in large quantities and engaging in late-night running.CASE SUMMARY Health care products contain a large amount of calcium phosphate,and we hypothesize that this could induce the formation of small phosphate stones.After exercise,the urinary system is abraded,resulting in bleeding.The patient was advised to stop using the health care products.Consequently,the aforementioned symptoms disappeared immediately.However,the patient resumed the above two habits one year later;correspondingly,the macroscopic hematuria reap-peared.CONCLUSION This finding further confirmed the above inference and allowed for a new avenue to determine the cause of the patient’s hematuria.

Safety and efficacy of transcatheter arterial embolization in autosomal dominant polycystic kidney patients with gross hematuria: Six case reports

BACKGROUND To retrospectively report the safety and efficacy of renal transcatheter arterial embolization for treating autosomal dominant polycystic kidney disease(ADPKD)patients with gross hematuria.CASE SUMMARY The purpose of this study is to retrospectively report the safety and efficacy of renal transcatheter arterial embolization for treating ADPKD patients with gross hematuria.Materials and methods:During the period from January 2018 to December 2019,renal transcatheter arterial embolization was carried out on 6 patients with polycystic kidneys and gross hematuria.Renal arteriography was performed first,and then we determined the location of the hemorrhage and performed embolization under digital subtraction angiography monitoring.Improvements in routine blood test results,routine urine test results,urine color and postoperative reactions were observed and analyzed.Results:Renal transcatheter arterial embolization was successfully conducted in 6 patients.The indices of 5 patients and the color of gross hematuria improved after surgery compared with before surgery.No severe complication reactions occurred.CONCLUSION For autosomal dominant polycystic kidney syndrome patients with gross hematuria,transcatheter arterial embolization was safe and effective.

Exercise-induced irisin in bone and systemic irisin administration reveal new regulatory mechanisms of bone metabolism

Irisin is a polypeptide hormone derived from the proteolytic cleavage of fibronectin-type III domain- containing 5 （FNDC5） protein. Once released to circulation upon exercise or cold exposure, irisin stimulates browning of white adipose tissue （WAT） and uncoupling protein I （UCP1） expression, leading to an increase in total body energy expenditure by augmented UCPl-mediated thermogenesis. It is currently unknown whether irisin is secreted by bone upon exercise or whether it regulates bone metabolism in vivo. In this study, we found that 2 weeks of voluntary wheel-running exercise induced high levels of FNDC5 messenger RNA as well as FNDC5/irisin protein expression in murine bone tissues. Increased immunoreactivity due to exercise-induced FNDC5/irisin expression was detected in different regions of exercised femoral bones, including growth plate, trabecular bone, cortical bone, articular cartilage, and bone-tendon interface. Exercise also increased expression of osteogenic markers in bone and that of UCP1 in WAT, and led to bodyweight loss. Irisin intraperitoneal （IP） administration resulted in increased trabecular and cortical bone thickness and osteoblasts numbers, and concurrently induced UCP1 expression in subcutaneous WAT. Lentiviral FNDC5 IP administration increased cortical bone thickness. In vitro studies in bone cells revealed irisin increases osteoblastogenesis and mineralization, and inhibits receptor activator of nuclear factor-kB ligand （RANKL）- induced osteoclastogenesis. Taken together, our findings show that voluntary exercise increases irisin production in bone, and that an increase in circulating irisin levels enhances osteogenesis in mice.

Single dose of intra-muscular platelet rich plasma reverses the increase in plasma iron levels in exercise-induced muscle damage:A pilot study

Background:Platelet rich plasma(PRP) therapy is widely used in enhancing the recovery of skeletal muscle from injury.However,the impact of intramuscular delivery of PRP on hematologic and biochemical responses has not been fully elucidated in exercise-induced muscle damage.The purpose of this investigation the effects of intramuscular delivery of PRP on hematologic and biochemical responses and recovery strategy muscle damage induced by high intensity muscle exercise(exercise-induced muscle damage,EIMD).Methods:Moderately active male volunteers participated in this study and were assigned to a control group(control,n = 6) and PRP administration group(PRP,n = 6).The subjects performed exercise with a load of 80% one repetition maximum(1RM) maximal voluntary contraction of the elbow flexors until point of exhaustion of the non-dominant arm was reached.The arms were treated with saline or autologous PRP post-24 h EIMD.Venous blood samples were obtained in the morning to establish a baseline value and 1–4 days post-exercise and were analyzed for serum ferritin,iron,iron binding capacity(IBC),creatinine kinase(CK),lactate dehydrogenase(LDH),aspartate aminotransferase(AST),and alanine aminotransferase(ALT).Results:The baseline levels of plasma iron,ferritin,IBC,CK,LDH,AST,and ALT were similar in both the control and PRP groups.However,24-h following exercise a significant increase in these parameters was observed in both groups between 1 and 4 days during the recovery period.Interestingly,PRP administration decreased plasma iron levels compared to the control on the second day post-exercise.Plasma IBC increased in PRP group from Days 2 to 4 post-exercise compared to the control group whilst PRP administration had no effect on plasma ferritin,CK,AST,ALT,or LDH.Conclusion:Acute exhaustive exercise increased muscle damage markers,including plasma iron,IBC,and ferritin levels,indicating muscle damage induced by exercise.PRP administration improves inflammation by reversing the increase in the iron levels post-exercise without displaying any myotoxicity and may have a role to play in the recovery of exercise-induced muscle damage.

Exercise-induced anaphylaxis with an Ayurvedic drug as cofactor:A case report

BACKGROUND The practice of Indian Ayurvedic medicine is spreading in Western countries and Shilajit is one of the most used drugs, for its antioxidant activities and immunomodulatory effects. Albeit Shilajit has showed a high degree of safety, it can act as cofactor of anaphylaxis, especially in condition at high risk, such as mast cell activation syndrome(MCAS). We reported this case to sensitize practitioners to investigate to the use of complementary and alternative medicine,in case of exercise-induced anaphylaxis(EIAn).CASE SUMMARY A 43-year-old woman, working as a dance teacher, developed urticaria after ingestion of rice, tuna and Shilajit, which did not respond to intramuscular corticosteroids. Subsequently, she developed dyspnoea and hypotension with loss of consciousness that arose 1 h after sexual activity. The patient did not refer personal history of atopy. Specific IgE for main food allergens resulted negative,with total IgE levels of 14 IU/L. Oral provocation test with Shilajit was not perfomed because the patient refused, but we performed prick-by-prick and patch test that resulted negative. Serum tryptase at the time of anaphylaxis was 20.6 μg/L that fell down to of 10.6 μg/L after therapy, but has remained at the high value after two days and during the follow-up. We performed an analysis of the c-KIT gene in peripheral blood, which was negative. We felt the diagnosis consistent with EIAn in a patient with a possible MCAS.CONCLUSION In Western countries the use of drugs from Ayurvedic medicine is more common than in the past. These substances can be cofactors of anaphylaxis in patients with risk factors.

Real-time surface electromyography in Parkinson's disease patients during exercise-induced muscle fatigue

To explore the mechanisms underlying exercise-induced local muscle fatigue in patients with idiopathic Parkinson＇s disease （PD）,we used surface electromyography to record myoelectric signals from the tibialis anterior muscle during isometric contraction-induced fatigue until exhaustion.The results revealed no significant differences between patients with idiopathic PD and healthy controls in maximum voluntary contraction of the tibialis anterior muscle.The basic characteristics of surface electromyography were also similar between the two groups.The duration of isometric contraction at 50% maximum voluntary contraction was shortened in PD patients.In addition,PD patients exhibited a stronger increase in mean square amplitude,but a weaker decrease in median frequency and mean power frequency compared with healthy controls during isometric contraction.The skeletal muscles of PD patients revealed specificity of surface electromyography findings,indicating increased fatigability compared with healthy controls.

EFFICACY OF ANTIHISTAMINE AGENTS ON MODEL FOR EXERCISE-INDUCED ASTHMA IN GUINEA PIGS

Objective To investigate the effects of antihistamine agents, loratadine and ketotifen, on the model of exercise-induced asthma in guinea pigs with lipopolysaccharide （LPS） and metyapone. Methods Nineteen guinea pigs were injected peritoneolly with LPS （ 1mg/kg, i. p. ） and metyapone （ 50mg/kg, i. p. ）. Then they were randomized into 3 groups. The control group （ n = 7） did not take any drug, ketotifen group （ n = 6） administered orally ketotifen （ Img·kg^-1· d^-1 ） and loratadine group （ n = 6） administered orally loratadine （ 2mg·kg^-1·d^-1 ） for 4 days. On thefifth day, lung resistance （RL） and dynamic compliance of respiratory system （Cdyn） of 3 groups were measured before and after exercise challenge. The total number of leukocytes in bronchoalveolar lavage fluid （BALF） from 3 groups was counted and differentiated cell type count was measured. Morphometric examination of the animal lungs was performed. Results In control group, RLincreased and Cdyn decreased significantly after exercise challenge. In ketotifen group and loratadine group with no change. There was a significant increase in the number of neutrophils, macrophages and eosinophils in BALF from control group. The infiltration of neutrophils in the bronchial mucosa was shown in control group in the morphometric study. Conclusion Loratadine and ketotifen can inhibit the exercise-induced bronchoconstriction in guinea pigs pretreated with LPS and metyrapone. Inhibiting the formation of inflammation in airway may be the therapeutic mechanism of these H-I receptor antagonists.

Exercise-Induced Bronchoconstriction Diagnostics:Impact of a Repeated Exercise Challenge Test

Exercise-Induced bronchoconstriction (EIB) is related to increased ventilation (VE) during exercise and describes the transient airway narrowing following exercise. A reliable diagnosis is essential for optimal treatment. The impact of a repeated exercise challenge test (ECT) in a clinical setting is not well established and conducting a repeated ECT with the possibility to adjust the exercise intensity on an individual basis may give more information. The aim of the study was to evaluate the test-retest reliability of an ECT for EIB and its association with exercise intensity. Methods: After examination by a pulmonologist, 20 referred subjects with symptoms strong indications of Exercise-Induced bronchoconstriction performed two consecutive exercise challenge tests on a treadmill. The exercise intensity of the repeated test was adjusted. Forced expiratory volume in 1 second (FEV1) was measured before and 1, 3, 6, 10, and 15 minutes after exercise. EIB was defined as a reduction of ≥ 10% in FEV1. Ventilation and heart rate were measured during exercise. Results: Five subjects tested positive in both tests, and ten subjects tested negative in both tests. Three subjects tested positive in the first test only, while two subjects tested positive in the second test only. The exercise intensity was not significantly different between the two tests for any of the subjects. Conclusion: There were 25% divergences in the diagnostic results of two consecutive exercise challenge tests. The difference in the test results was not explained by a difference in the exercise intensity.

IgA肾病的中西医诊治进展

IgA肾病是一种原发性肾小球肾炎,容易引起肾损害,最终导致终末期肾病,使患者进入肾替代治疗阶段,给患者及其家庭带来严重的心理及经济负担。针对IgA肾病,西医逐渐研制各种靶向药物但疗效及不良反应仍需观察。文献、临床实践表明,中医药治疗IgA肾病可有效减少尿蛋白及尿红细胞,有效延缓肾功能减退,且无毒副作用。现收集大量文献,从中医对IgA肾病的病因病机认识及西医对IgA肾病的发病机制研究和治疗进行总结,让更多的青年医师借鉴学习,为更多的IgA肾病患者带来福音。

基于玄府开阖不利探讨IgA肾病的中医辨治思路

从刘完素玄府进一步阐发,认为玄府开阖不利是“玄闭”的内涵,非独因阖而闭。玄府开阖不利贯穿IgA肾病全过程,肺肾气虚、外玄开阖不利、风热毒乘虚而入是始动机制,热毒伏里、内玄因郁而闭关乎病势进展,痰瘀胶阻、内玄痿废而闭、兼有神机不遂,是IgA肾病进展的结局。作者以疏通玄府为IgA肾病的基本辨治思路,分6个层次详述具体治法。“通玄”常融合多法,首重辛药直接开通。但不囿于辛通一端,认为以补为通及清除浊瘀等病理产物的间接通玄法亦甚关键,根本目的是恢复气血流通、神机运转。

以血尿为分类因素的IgA肾病CKD1~4期患者中医证型差异

目的:通过探讨临床表现为单纯蛋白尿、蛋白尿伴血尿的IgAN患者二者间中医证型差异,阐明血尿证候基础,为IgAN临床辨证分型及指导其治疗提供参考依据。方法:采用流行病学现场调查的方法,收集230例IgAN患者的临床及病理资料,根据有无血尿症状分为单纯蛋白尿组(A组107例)和蛋白尿伴血尿组(B组123例)。观察比较两组间临床指标、病理分型、中医证型的差异,再分别与血尿进行相关性分析。结果:(1)一般资料:两组间年龄、性别、体重指数、病程、血压差异均无统计学意义(P>0.05);(2)生化指标:B组Scr、24 h UTP高于A组(P<0.05),eGFR低于A组(P<0.05);两组UA、BUN、Alb差异无统计学意义(P>0.05)。(3)病理资料:B组系膜增殖评分(M)、毛细血管内增生性病变(E)高于A组(P<0.05);两组肾小球节段性硬化或黏连(S)、肾小管萎缩或间质纤维化(T)差异无统计学意义(P>0.05)。(4)中医证型:本虚证A组以脾肾气虚证多见(36.45%),B组以气阴两虚证多见(42.28%);标实证A组以血瘀证多见(50.94%),B组以湿热证多见(57.39%)。(5)血尿的相关因素分析:将两组患者临床指标、病理资料、中医证型分别与血尿进行logistic回归,肾衰竭、中大量尿蛋白(24 h UTP≥1.0 g)、M1、E1、气阴两虚证、湿热证P<0.05,且OR值>1,与血尿相关。结论:(1)CKD1~4期IgAN患者血尿的证候基础可能为气阴两虚兼湿热,蛋白尿的证候基础可能多为脾肾气虚和血瘀;分布规律尤其在CKD1~2期患者更明显。(2)与单纯蛋白尿的IgAN患者相比,血尿可能是蛋白尿伴血尿患者预后不良的因素之一。在治疗时应充分认识到血尿在病程中的重要性,不能忽略血尿的治疗。

小蓟饮子加减防治经尿道前列腺钬激光剜除术后血尿的临床效果研究

目的观察小蓟饮子加减防治经尿道前列腺钬激光剜除术(HoLEP)后血尿的临床疗效。方法选取60例前列腺增生患者,根据治疗方案分为观察组和对照组,各30例。所有患者均行HoLEP,对照组术后给予常规治疗加氨甲苯酸注射治疗,观察组术后在对照组基础上给予小蓟饮子加减治疗。比较两组术后的相关指标(膀胱冲洗时间、留置导尿管时间、术后住院时间);术后6 h、术后第1~4天导尿管引流液颜色;术后1个月的并发症(血尿、尿道狭窄、尿路感染、尿失禁)发生率。结果观察组的膀胱冲洗时间、导尿管留置时间、术后住院时间分别为(40.50±3.48)h、(5.13±0.78)d、(5.20±0.96)d,均比对照组的(52.70±3.92)h、(6.87±0.73)d、(7.03±0.72)d短(P<0.05)。术后6 h,两组引流液颜色相似(P>0.05);术后第1~4天,观察组导尿管引流液颜色均优于对照组(P<0.05)。观察组术后并发症发生率13.33%低于对照组的40.00%,差异有统计学意义(P<0.05)。结论小蓟饮子能够明显改善前列腺增生患者HoLEP术后相关指标、出血程度和血尿持续时间,降低并发症发生率,提高患者术后生活质量。

基于中医传承辅助平台因地制宜探究北方肾性血尿病机规律

目的:运用中医传承辅助平台(V3.0)归纳治疗肾性血尿的用药,结合何学红教授经验验证分析北方地区肾性血尿病机规律。方法:于中国期刊全文数据库、万方数据库、维普数据库以及中国生物医学文献数据库等检索出2012年-2022年有关北方地区中医药治疗肾性血尿的文献,收集筛选相关方药录入中医传承辅助系统(V3.0)进行数据挖掘,对核心药物的频数、组方规律、关联规则等进行规律性分析。结果:对筛选出的112首方剂,共220味中药进行用药频次统计,获得19味用药频次≥20的中药,其中前5位分别为黄芪、小蓟、生地黄、白茅根、牡丹皮。四气五味分析得到处方中寒性及温性药物使用较多,五味分析发现甘味及苦味药使用频率最高。药物归经方面依次为肝经、肺经、肾经及脾经。药物关联规则分析确定常用药物组合18个,核心药物共12味,居前5位的组合分别是“黄芪、白术”“小蓟、白茅根”“生地黄、牡丹皮”“黄芪、山茱萸”和“墨旱莲、女贞子”。基于k均值聚类算法的组方规律分析得出核心组合4个。结论:基于中医传承辅助平台对北方地区中医药治疗肾性血尿的用药进行数据分析,结合何学红教授临床经验,验证北方地区肾性血尿病机多为脾肾两虚兼肝郁气滞,治疗上可在补益脾肾的同时佐以疏肝行气之药,为临床提供参考。

李新民教授辨治小儿单纯性血尿之经验

李新民教授临证治疗小儿单纯性血尿,在中医传统理法方药的指导下,立足于卫气营血辨证、脏腑辨证、三焦辨证,以多维辨证作为证治思路,从多辨证体系交汇共通之处求得共通点。其认为热邪致病贯穿小儿血尿的全过程,将本病分为风热侵袭,扰动肾络;脾虚肝热,血不循经;脾失健运,统摄失司;热淫于内,迫血妄行4个证候类型。针对不同的证候类型提出了相应的治法:疏风宣肺、清解上焦、清络凉血;疏肝理脾、宣化中焦、清热凉血;疏运调中,辛开苦降,健脾摄血;清热泻火,和络化瘀,凉血止血。结合小儿特有体质在选方用药上多以微苦微辛之品,疏解外散时邪;辛开苦降之味,调畅周身气机;寒温燥润相伍,顺应脏腑特性。立足于病机四要素,灵活应用药物性味,巧妙协调脏腑功能,调畅脏腑气机,不拘泥于疾病当前的证候状态,而是以动态的辨证思路,从治法搭配,药物配伍方面得出治疗该病的较为优势的治疗方案。验于临床,疗效明显,附典型医案一则加以佐证。

Urological Emergencies at the University Hospital of Brazzaville: Epidemiological, Clinical, and Therapeutic Aspects

Introduction: Urological emergencies play a significant role in the medical and surgical activity of a urology department. The objective of this study was to determine the hospital prevalence of urological emergencies at the University Hospital of Brazzaville (CHUB), identify the different pathologies requiring urgent care, and list the various therapeutic methods. Patients and methods: A retrospective study of patients admitted to the medical and surgical emergencies department of CHUB over a 5-year period. Patient records admitted and treated for a urological emergency were included. The variables studied were the frequency of urological emergencies, patient age at admission, gender, nature of the emergency, and various therapeutic options. Results: Urological emergencies accounted for 4.3% of all medical and surgical emergencies. The mean age was 57 ± 28 years with a range of 3 to 93 years. The male-to-female ratio was 7.1. The most common conditions were urinary retention (54.67%), hematuria (17.20%), and renal colic (8.13%). Therapeutically, surgical urinary drainage was dominated by cystostomy. Conclusion: Urological emergencies are infrequent at the University Hospital of Brazzaville. Their management is often delayed.

清热利湿止血汤治疗湿热内蕴型肾小球源性血尿患者疗效及对尿隐血红细胞计数水平的影响

目的探讨清热利湿止血汤治疗湿热内蕴型肾小球源性血尿患者疗效及对尿隐血、红细胞计数水平的影响。方法选取2021年9月至2023年9月在浙江省丽水市人民医院确诊的160例肾小球源性血尿患者,按治疗方法分为治疗组(80例)和对照组(80例)。对照组采用西医常规治疗方案,治疗组在对照组基础上采用清热利湿止血汤,均治疗3个月。比较2组患者的中医证候积分、疗效、不良反应发生情况,在治疗前后比较2组患者尿隐血、红细胞、尿蛋白定量(24 h)、离心红细胞情况。结果治疗后,关于尿道灼痛、腰酸腹胀、足心灼热中医证候评分,治疗组得分分别为(0.84±0.13)分、(0.74±0.19)分、(1.05±0.26)分,对照组得分分别为(1.15±0.18)分、(1.38±0.22)分、(1.34±0.31)分,2组得分均低于治疗前,且治疗组低于对照组(P<0.05);治疗后,治疗组有效率93%高于对照组81%(P<0.05);治疗后,治疗组红细胞计数、离心红细胞数量、尿蛋白定量(24 h)分别为(195±42)个/μl、(13±3)个/HP、(0.58±0.24)g/24 h,对照组分别为(220±52)个/μl、(16±4)个/HP、(0.73±0.31)g/24 h,2组均低于治疗前,且治疗组低于对照组(P<0.05);治疗后,治疗组尿隐血(++++)、(+++)、(++)例数低于对照组,(+)、(-)例数高于对照组(P<0.05);治疗后,治疗组不良反应发生率4%,对照组11%,2组差异无统计学意义(P>0.05)。结论清热利湿止血汤可以改善湿热内蕴型肾小球源性血尿的血尿症状,降低尿隐血、红细胞水平,具有良好的临床疗效。

盛梅笑论治肾炎血尿经验浅析

肾炎血尿是因免疫炎症反应使红细胞从受损的肾小球滤过膜屏障随尿液排出所导致的血尿。以肺脾肾正气虚损为发病的内在因素,外邪侵袭是诱发和加重因素,风邪内扰或湿热浸淫,肾络受损,血溢于下,发为血尿,久病风湿瘀热之邪相兼为患而致病。基于此,盛梅笑教授提出临证当以补肺益肾健脾为本,清利湿热贯穿病程,辅以凉血止血、化瘀止血、收敛固涩等法。