Improvement of lenvatinib-induced nephrotic syndrome after adaptation to sorafenib in thyroid cancer:A case report

BACKGROUND Target therapy is licensed by United States Food and Drug Administration on certain cancers.Both sorafenib and lenvatinib are tyrosine kinase inhibitor and indicated on radioactive iodine(RAI)-refractory differentiated thyroid cancer(DTC).Lenvatinib is more effective in cancers'control than sorafenib,but causes more nephrotoxicity than sorafenib does.This case is the second published case about the serial adaptions from lenvatinib to sorafenib for improving the proteinuria and,meanwhile,achieving the therapeutic goal.CASE SUMMARY A 56-year-old man suffered from bilateral edematous lower extremities after 1-mo prescription of lenvatinib of 20 mg/d for RAI-refractory DTC.Aside from this symptom,he also developed hypertension.His laboratory showed grade-3 proteinuria(estimated 24-h urine protein:9993 mg),hypoalbuminemia and hypercholesterolemia.Anti-vascular endothelial growth factor(VEGF)therapyinduced nephrotic syndrome was impressed.After reduced dosage of lenvatinib of 10 mg/d and related symptomatic drugs,limited improvement was observed in both adverse effects and caner control.Under this condition,we substituted sorafenib of 400 mg/d for lenvatinib of 10 mg/d.After a 5-mo prescription,not only hypertension and peripheral edema were greatly improved,but also proteinuria was improved from grade three to grade one(estimated 24-h urine protein:962 mg).At the same time the cancer control was achieved,judged from computed tomography and laboratory evidence[thyroglobulin(Tg)before prescription of sorafenib:354.7 ng/m L;Tg after prescription of sorafenib:108.9 ng/m L].CONCLUSION Adaption from lenvatinib to sorafenib is a feasible method to improve the antiVEGF therapy-induced nephrotic syndrome and achieve the therapeutic goal at the same time.

Constipation-predominant irritable bowel syndrome: A review of current and emerging drug therapies

Irritable bowel syndrome(IBS) is a highly prevalent medical condition that adversely affects patient quality of life and constitutes a significant economic burden on healthcare resources. A large proportion of patients suffer from the constipation subtype of IBS(IBS-C), most commonly afflicting older individuals and those with a lower socioeconomic status. Conventional pharmacologic and nonpharmacologic treatment options have limited efficacies and/or significant adverse events, which lead to increased long-term health care expenditures. Failure to effectively treat IBS-C patients over the past decades has largely been due to a poor understanding of disease pathophysiology, lack of a global view of the patient, and an inappropriate selection of patients and treatment endpoints in clinical trials. In recent years, however, more effective and safer drugs have been developed for the treatment of IBS-C. The advancement in the area of pharmacologic treatment is based on new knowledge of the pathophysiologic basis of IBS-C and the development of drugs with increased selectivity within pharmacologic classes with recognized efficacies. This narrative review covers the spectrum of available drugs and their mechanisms of action, as well as the efficacy and safety profiles of each as determined in relevant clinical trials that have investigated treatment options for IBS-C and chronic constipation. A brief summary of laxative-based treatment options is presented, followed by up-to-date assessments for three classes of drugs: prokinetics, prosecretory agents, and bile acid modulators.

Long-term Effect of TCM Decoctions in Treatment of Nephrotic Syndrome

Fifty-seven cases of nephrotic syndrome were treated with TCM decoctions as accessory treatment for prednisone and cyclophosphamide, and the effects were observed in a follow-up period of 5-15 years. The long-term complete remission rate of 68.4% and recurrence rate of 26.3% in the treatment group were respectively higher and lower than those in the control group (P

Effects of the Integrated TCM-WM Treatment of Nephrotic Syndrome on Growth and Sexual Development

Fifty children with nephrotic syndrome were treated by using herbal drugs for nourishing yin to reduce pathogenic fire, strengthening qi and tonifying the kidney, and promoting blood circulation and removing blood stasis in combination with glucocorticoid and immunodepressant. The body height, secondary sex characters, age of the first spermatorrhea for male and of menarche for female children, bone age measured with roentgenograms on the left wrist in 50 cases of the treatment group were compared with those in 31 cases of the control group treated by glucocorticoid and immunodepressant. The results showed that the delay of growth and sexual development as side-effects of glucocorticoid and immunodepressant were markedly reduced by the integrated TCM-WM treatment.

Analysis of Adverse Drug Reactions Caused by Chinese Patent Medicine Treatment Based on Kidney Damp-heat Syndrome and Damp-turbidity Syndrome

[Objectives]To determine relationship of the adverse drug reaction(ADR)occurrence of the single use and combined use of Huangkui Capsule and Haikun Shenxi Capsule.[Methods]To determine relationship of the ADR occurrence of the single use and combined use of Huangkui Capsule and Haikun Shenxi Capsule.[Results]The main adverse drug reactions of the single use of Huangkui Capsule or Haikun Shenxi Capsule was severe diarrhea(n=7,n=9),however the combined use of the two resulted in more occurrence of adverse drug reactions(n=23)with significant difference in contrast to the single use group(P=0.0015,P=0.0069).[Conclusions]When traditional Chinese patent medicines are used in combination to treat kidney damp-heat syndrome and damp-turbid syndrome,it is necessary to pay close attention to the occurrence of adverse drug reactions,especially the digestive system.

Effects of Chinese herbal medicine Yiqi Huaju Formula on hypertensive patients with metabolic syndrome:a randomized,placebo-controlled trial

BACKGROUND： Patients with hypertension coupled with metabolic syndrome （MetS） are among the high risk population in cardiovascular and cerebrovascular diseases. To reduce the prevalence of cardiovascular and cerebrovascular diseases, it is essential to appropriately control b^ood pressure together with other cardiovascular risk factors. OBJECTIVE： The current study was designed to investigate the therapeutic effects on blood pressure, blood pressure variability and other cardiovascular risk factors by giving Yiqi Huaju Formula, a compound traditional Chinese herbal medicine, in addition to routine treatment to hypertensive patients coupled with MetS. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS： A total of 43 patients with hypertension coupled with MetS were recruited into this study. The enrolled patients were randomly divided into the Chinese herbal formula group （anti-hypertensive drugs plus Yiqi Huaju Formula, CHF） and the control group （anti-hypertensive drugs plus placebo）. The CHF group enrolled 22 patients while the control group received 21 cases. Treatments were given for 12 weeks in both groups. MAIN OUTCOME MEASURES： Parameters examined include 24-hour ambulatory blood pressure monitoring, body mass index, waist circumference, waist-to-hip ratio, homeostatic model assessment for insulin resistance （HOMA-IR）, fasting glycosylated hemoglobin （HbAlc）, fasting plasma glucose, 2-hour postprandial plasma glucose （PPG）, fasting plasma insulin, serum lipid, etc. RESULTS： Compared with the control group, the CHF group had significant improvement （P〈0.01） in anthropometric parameters, FPG, HOMA-IR, blood pressure amplitude, blood pressure variability and blood pressure load. CONCLUSION： This study showed that integrated traditional Chinese and Western medicine treatment can achieve better results in controlling blood pressure as well as other cardiovascular risk factors. The mechanism of controlling of blood pressure may be associated with the improvement of insulin sensitivity due to the Yiqi Huaju intervention. TRIAL REGISTRATION IDENTIFIER： ChiCTR-TRC-11001633.

Study of HIV-1 Drug Resistance in Patients Receiving Free Antiretroviral Therapy in China

To investigate the prevalence of drug-resistance mutations,resistance to antiretroviral drugs,and the subsequent virological response to therapy in treatment-naive and antiretroviral-treated patients infected with HIV/AIDS in Henan,China,a total of 431 plasma samples were collected in Queshan county between 2003 and 2004,from patients undergoing the antiretroviral regimen Zidovudine + Didanosine + Nevirapine(Azt+Ddi+Nvp).Personal information was collected by face to face interview.Viral load and genotypic drug resistance were tested.Drug resistance mutation data were obtained by analyzing patient-derived sequences through the HIVdb Program(http://hivdb.stanford.edu).Overall,38.5% of treatment-naive patients had undetectable plasma viral load(VL),the rate significantly increased to 61.9% in 0 to 6 months treatment patients(mean 3 months)(P<0.005)but again significantly decrease to 38.6% in 6 to 12 months treatment patients(mean 9 months)(P<0.001)and 40.0% in patients receiving more than 12 months treatment(mean 16 months)(P<0.005).The prevalence of drug resistance in patients who had a detectable VL and available sequences were 7.0%,48.6%,70.8%,72.3% in treatment-na?ve,0 to 6 months treatment,6 to 12 months treatment,and treatment for greater than 12 months patients,respectively.No mutation associated with resistance to Protease inhibitor(PI)was detected in this study.Nucleoside RT inhibitor(NRTI)mutations always emerged after non-nucleoside RT inhibitor(NNRTI)mutations,and were only found in patients treated for more than 6 months,with a frequency less than 5%,with the exception of mutation T215Y(12.8%,6/47)which occurred in patients treated for more than 12 months.NNRTI mutations emerged quickly after therapy begun,and increased significantly in patients treated for more than 6 months(P<0.005),and the most frequent mutations were K103N,V106A,Y181C,G190A.There had been optimal viral suppression in patients undergoing treatment for less than 6 months in Queshan,Henan.The drug resistance strains were highly prevalent in antiretroviral-treated patients,and increased with the continuation of therapy,with many patients encountering virological failure after 6 months therapy.

《中国老年代谢综合征药物治疗专家共识(2022)》解读

老年代谢综合征是一组复杂的代谢紊乱症候群,其作为一种共病发病率高,临床表现多样,机制复杂且涉及联合用药,发生药物不良反应的风险高。老年代谢综合征严重损害老年人的生活质量和健康,给我国医疗系统及社会造成沉重的负担。《中国老年代谢综合征药物治疗专家共识(2022)》全面梳理和总结了老年代谢综合征的诊断标准和治疗目标、最新治疗药物及其相互作用,并做出10条推荐意见。该文就共识要点特别是药物治疗方面进行解读,以期为老年代谢综合征药物治疗决策与健康管理提供相关参考。

系统性红斑狼疮患者应用靶向B细胞治疗后发生中枢神经系统病变文献病例分析

目的探讨系统性红斑狼疮(SLE)患者经靶向B淋巴细胞生物制剂治疗后发生中枢神经系统不良反应的临床特征。方法检索国内外相关数据库(截至2023年5月),收集系统性红斑狼疮患者经贝利尤单抗、利妥昔单抗治疗后发生中枢神经系统病变的病例报告类文献,提取患者的基本信息、贝利尤单抗或利妥昔单抗用药情况(用法用量、单用或联用、联用方案等)、中枢神经系统病变发生时间、临床表现、影像学特征、临床治疗及转归等,并进行描述统计分析。结果检索到进行性多灶性脑白质病(PML)患者14例,发病年龄(50.71±11.45)岁;可逆性后部脑病综合征(PRES)患者24例,发病年龄(30.67±14.93)岁。纳入有详细病例报道的患者共7例,7例患者均未合并HIV感染、恶性肿瘤及其他自身免疫性疾病。7例患者均经磁共振检查确诊,均未行脑组织活检。临床表现:癫痫5例,视物模糊或视力丧失3例,构音障碍或失语2例,头痛2例,昏迷1例,血压升高4例。最终7例患者中1例死亡。结论应用靶向B细胞治疗后,SLE患者中枢神经系统副作用多发生在疾病活动期且合并使用其他免疫抑制剂时。患者的临床表现容易与神经精神狼疮混淆,导致病情延误,提示在使用靶向B细胞生物制剂治疗时,应评估SLE患者发生中枢神经系统副作用的潜在风险。

奥利司他对多囊卵巢综合征伴胰岛素抵抗患者的疗效及安全性

目的 探讨奥利司他对多囊卵巢综合征(PCOS)伴胰岛素抵抗(IR)患者的治疗效果及安全性。方法 依据稳态模型法评估的胰岛素抵抗指数(HOMA-IR)选取2020年8月至2023年8月泰州市中医院收治的104例PCOS-IR患者,按随机数字表法分为对照组52例(失访2例)和试验组52例(失访5例)。对照组患者给予炔雌醇环丙孕酮,试验组患者给予奥利司他,两组均治疗3个月。对比两组患者机体测量学指标、糖脂代谢水平、激素水平及产生的不良反应。结果 治疗后,试验组患者BMI、体质量、腰围[分别为(25.74±1.08) kg·m^(-2)、(59.23±2.80) kg、(94.10±5.13) cm]均低于对照组[分别为(26.23±1.26) kg·m^(-2)、(60.51±2.31) kg、(96.5±5.20) cm](t=2.050、2.462、2.287,均P<0.05),总胆固醇(TC)、甘油三酯(TG)、空腹血糖(FPG)、HOMA-IR[分别为(3.86±0.73) mmol·L^(-1)、(1.68±0.72) mmol·L^(-1)、(3.75±0.88) mmol·L^(-1)、(1.61±0.37)]均低于对照组[分别为(5.12±0.13) mmol·L^(-1)、(1.98±0.43) mmol·L^(-1)、(4.78±0.35) mmol·L^(-1)、(2.78±0.43)](t=12.007、2.508、7.659、14.323,均P<0.05);两组患者治疗后卵泡雌激素(FSH)差异无统计学意义[(6.71±0.69) mIU·mL^(-1) vs(6.79±0.72) mIU·mL^(-1),t=0.558,P>0.05)],试验组总睾酮(T)、血清黄体生成素(LH)、LH/FSH[(1.38±0.22) nmol·L^(-1)、(6.24±0.78) IU·L^(-1)、(0.93±0.15)]均低于对照组[(1.84±0.27) nmol·L^(-1)、(7.12±0.83) IU·L^(-1)、(1.05±0.17)](t=9.165、5.373、3.677,均P<0.05);两组不良反应发生率差异无统计学意义(8.50%vs 10.00%,χ^(2)=0.064,P>0.05)。结论 奥利司他治疗PCOS-IR患者能有效减重,调节糖脂代谢及性激素水平,改善胰岛素抵抗,且安全性良好。

金匮肾气丸联用cART对HIV-1感染者的疗效及不良反应分析

获得性免疫缺陷综合征(acquired immunodeficiency syndrome,AIDS)的主要治疗方法为联合抗逆转录病毒治疗(combined antiretroviral therapy,cART),但部分患者由于免疫功能重建不全和不良反应,可能出现药物性肝损伤、消化功能下降、神经系统毒性和代谢紊乱等,严重影响了抗病毒疗效和患者生存质量,已成为AIDS治疗领域的瓶颈[1]。部分国家资助的中医药防治AIDS科研课题提出正虚(主要为肾虚)是AIDS发生发展的内在病理基础,以肾气与肾阴肾阳的功能下降为主要特征[2-3]。补肾制剂可能是缓解人类免疫缺陷病毒(human immunodeficiency virus,HIV)感染患者病情和不良反应的可靠方式。金匮肾气丸是由地黄、山药、茯苓、牡丹皮、山茱萸、牛膝、泽泻等多味中药制成的综合制剂[4],具有温补肾阳、化气行水的作用。本研究首次采用金匮肾气丸与cART联用治疗HIV-1感染者,比较了金匮肾气丸与cART联用、单用cART对HIV-1感染者抗病毒疗效和不良反应的差异,试图为探索HIV-1感染者治疗的新途径提供参考。

艾博韦泰联合多替拉韦治疗HIV感染/AIDS多重耐药1例报道

随着抗反转录病毒治疗(antiretroviral therapy,ART)的快速启动和推广,HIV感染已成为一种可以治疗的慢性传染病,然而治疗期间若ART不规范或患者依从性差可引起耐药变异。本研究报道1例30岁多重耐药HIV感染者使用艾博韦泰(albuvirtide,ABT)联合多替拉韦(dolutegravir,DTG)的治疗经过。患者治疗失败后行HIV耐药检测,结果显示患者对核苷类逆转录酶抑制剂、非核苷类逆转录酶抑制剂及蛋白酶抑制剂中的多种药物存在不同程度耐药,在既往药物中仅对整合酶抑制剂类药物敏感。结合患者HIV耐药检测结果,治疗方案更换为“ABT+DTG”,患者病毒复制被成功抑制,且患者在8个月治疗过程中免疫功能逐步提升。而后因个人原因,患者短暂停用“ABT+DTG”治疗1个月,免疫水平下降,病毒载量出现反跳。后行“ABT+DTG”方案治疗至2023年3月,CD4^(+)T淋巴细胞计数平稳升高至291×10^(6)个/L,病毒载量持续降低至小于40×10^(3)copies/L,治疗期间患者耐受性及安全性较好。提示ABT联合DTG方案是HIV多重耐药患者一种新的治疗选择。

基于AGREEⅡ的急性冠脉综合征患者抗血小板药物治疗的指南评价

目的:采用临床指南研究与评估系统Ⅱ(AGREEⅡ)工具,对2010—2019年国内外公开发表的急性冠脉综合征(ACS)患者抗血小板药物治疗相关临床实践指南进行方法学评价。方法:选取2010—2019年国内外公开发表的ACS患者抗血小板药物治疗指南及相关文献为研究对象,使用AGREEⅡ对其进行系统评价,并分析各指南推荐内容的差异。结果:共纳入相关文献10篇,其中7篇治疗指南,3篇专家建议与共识。AGREEⅡ各领域的平均得分,范围和目的为(82.5±8.7)%,参与人员为(67.5±15.3)%,制定的严谨性为(68.7±18.2)%,表达的清晰性为(89.3±4.0)%,应用性为(68.1±13.8)%,编辑的独立性为(54.8±12.3)%,总体评价为(65.7±12.3)%。组内相关系数及95%CI为0.89(0.72~0.92),说明研究员评分一致性较高。指南均推荐术后使用阿司匹林+P2Y12受体拮抗剂双联抗血小板治疗。结论:临床实践指南用药推荐术后使用阿司匹林+P2Y12受体拮抗剂双联抗血小板治疗,用药疗程为12个月。ACS患者非必要无需进行基因检测。

小剂量利妥昔单抗改善早期中高风险膜性肾病疾病进展:一项探索性研究

膜性肾病(membranous nephropathy,MN)是成人原发性肾病综合征(nephrotic syndrome,NS)最常见的病因,近年来研究发现PLA2R是MN的关键致病靶抗原,且其发现给利妥昔单抗(rituximab,RTX)等靶向B细胞的治疗提供了理论基础,然而针对抗体的早期干预是否能有效地阻止MN的进展仍有待进一步探索。我们系统分析了2019年10月至2023年3月在我中心接受RTX治疗的13例PLA2R抗体相关早期中高危MN患者的临床特征和随访。早期中高危MN定义为基线或入院时抗PLA2R抗体滴度超过50 RU/mL,但尚未出现NS状态。患者在基线评估中位时间4.1个月(IQR 1-7.7)启动RTX治疗,此后中位随访时间为27个月(IQR 23-45),期间均未发展至NS,12例(92.3%)在随访2年或末次随访时评估为完全或部分缓解。随访期间未发生死亡、严重感染或其他严重不良反应。RTX对早期中高危MN患者具有良好的疗效和安全性,适时启动抗体清除治疗可能有利于长期疾病控制和远期肾脏预后。

足浴疗法对肾病综合征瘀血证患者凝血功能的影响

目的:观察足浴疗法对肾病综合征瘀血证患者凝血功能的影响。方法:选取70例肾病综合征患者,按随机数字表法分为治疗组及对照组各35例。对照组接受抗凝治疗,治疗组在对照组基础上采用中药足浴疗法治疗。比较2组临床疗效,比较2组治疗前后凝血指标[凝血酶原时间(PT)、国际化标准比值(INR)、部分凝血酶原时间(APTT)、纤维蛋白原(FIB)、凝血酶时间(TT)、D-二聚体(DD)、PT正常对照值]、肾功能指标[血尿氮素(BUN)、血清肌酐(SCr)、血白蛋白、尿蛋白定量]的变化。结果:治疗组临床疗效为94.29%,对照组为80.00%,2组临床疗效比较,差异有统计学意义(P<0.05)。治疗后,2组PT、INR、APTT、DD、PT正常对照值水平组内、组间比较,差异无统计学意义(P>0.05)。治疗后,2组FIB、TT水平均较治疗前下降(P<0.05),治疗组FIB、TT水平均低于对照组(P<0.05)。治疗后,2组尿蛋白定量、BUN、SCr水平均较治疗前下降(P<0.05),血白蛋白水平均较治疗前升高(P<0.05);治疗组尿蛋白定量、BUN、SCr水平均低于对照组(P<0.05),血白蛋白水平高于对照组(P<0.05)。结论:足浴疗法治疗肾病综合征瘀血证能够改善患者高凝状态和肾功能指标值,辅助抗凝治疗。

益气养阴法联合西药治疗肾病综合征的疗效及安全性的Meta分析

【目的】系统评价益气养阴法联合西药治疗肾病综合征的有效性及安全性。【方法】检索中国知网(CNKI)、中国生物医学文献数据库(CBM)、万方(Wangfang)、维普(VIP)、PubMed、Web of Science、Cochrane Library、Embase等国内外主要文献数据库,筛选其中有关益气养阴法联合西药(试验组)对比单纯西药(对照组)治疗肾病综合征的临床随机对照试验(RCTs),采用Cochrane手册中的偏倚风险工具进行文献的质量评价,运用RevMan 5.3软件进行Meta分析。【结果】共纳入18个RCTs,包含1334例患者。Meta分析结果显示,益气养阴法联合西药在提高临床有效率(RR=1.24,95%CI[1.16,1.32],P<0.00001),改善24 h尿蛋白定量(24hUPRO)(MD=-0.92,95%CI[-1.09,-0.75],P<0.00001)、血清白蛋白(ALB)(MD=7.06,95%CI[4.73,9.39],P<0.00001)、尿素氮(BUN)(MD=-1.57,95%CI[-2.01,-1.13],P<0.00001)、血肌酐(SCr)(MD=-12.23,95%CI[-16.58,-7.88],P<0.00001)、总胆固醇(TC)(MD=-1.06,95%CI[-1.69,-0.43],P=0.0009)、甘油三酯(TG)(MD=-0.58,95%CI[-0.94,-0.21],P=0.002)水平,以及降低不良反应发生率(RR=0.50,95%CI[0.40,0.64],P<0.00001)方面优于单纯西药治疗。【结论】益气养阴法联合西药治疗肾病综合征在提高临床疗效及改善24hUPRO、ALB、BUN、SCr、TC、TG方面优于单纯西药治疗,且能降低激素产生的不良反应。因纳入文献较少,文献质量较低,潜在疗效需更多的高质量研究进行验证。

便秘型肠易激综合征的治疗进展

便秘型肠易激综合征(IBS-C)是肠易激综合征中的一种亚型,由于其发病机制尚不十分明确,因此在治疗方面尚无特异性方法,主要是以缓泻剂治疗,但它在完全缓解症状及预防复发上难以达到满意的疗效。近年来,不断研发新的药物和持续更新相关临床指南使IBS-C的诊疗得到了进一步的发展。基于此,本综述着重总结了当前治疗IBS-C的研究进展,以期为临床实践提供依据及支持。

罗沙司他联合基础疗法治疗原发性肾病综合征继发急性肾损伤患者的临床效果

目的探讨罗沙司他联合基础疗法治疗原发性肾病综合征(PNS)继发急性肾损伤(AKI)患者的临床效果,以期为PNS继发AKI患者临床治疗方案的选择提供参考。方法选取2022年7月—2023年5月重庆大学附属中心医院收治的118例PNS继发AKI患者,采用随机数字表法分为对照组和研究组,每组59例。对照组患者采用基础疗法治疗,研究组患者在对照组基础上联合罗沙司他治疗。比较2组患者的临床疗效,治疗前后的肾功能指标[血清肌酐(SCr)、尿素氮(BUN)、肾小球滤过率(eGFR)]、24 h尿蛋白定量(24 h Upro)、血浆白蛋白、血脂指标[甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)]、血常规指标[白细胞计数(WBC)、红细胞计数(RBC)、血红蛋白(Hb)、血小板计数(PLT)]及肝功能指标[白蛋白(ALB)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、总胆红素(TBIL)],并进行安全性评估。结果研究组患者的治疗总有效率为91.53%(54/59),高于对照组的77.97%(46/59),差异有统计学意义(χ^(2)=4.196,P=0.041)。2组患者不同治疗时间点的血清SCr、BUN水平及eGFR重复测量方差分析的组间、时间及交互效应比较,差异均有统计学意义(P<0.05);研究组患者治疗7 d、14 d及28 d时的SCr、BUN水平均低于同一时间点的对照组,eGFR高于同一时间点的对照组,差异均有统计学意义(P<0.05)。2组患者不同治疗时间点的24 h Upro、血浆白蛋白、TC及TG水平重复测量方差分析的组间、时间及交互效应比较,差异均有统计学意义(P<0.05);研究组患者治疗14 d及28 d时的24 h Upro、TC与TG水平均低于同一时间点的对照组,血浆白蛋白水平高于同一时间点的对照组(P<0.05);2组患者治疗前后LDL-C及HDL-C水平比较,差异无统计学意义(P>0.05)。2组患者治疗前及治疗28 d时的WBC、RBC、Hb、PLT、ALB、ALT、AST、TBIL水平比较,差异均无统计学意义(P>0.05)。研究组与对照组患者不良反应发生率分别为3.39%(2/59)和1.69%(1/59),差异无统计学意义(P>0.05)。结论罗沙司他联合基础疗法治疗PNS继发AKI患者的疗效确切,能有效改善患者肾功能与血脂代谢,具有较高的用药安全性,且对患者肝功能影响较小,值得在临床推广。

李伟伟教授基于风气百疾理论辨治儿童肾病综合征经验

儿童肾病综合征(NS)是常见的儿科肾脏慢性疾病,患儿常因感染而致病情反复发作,其中以呼吸道感染居多,病情复发给患儿预后及生活质量带来诸多影响。NS缓解期患儿常有肺脾肾三脏虚损,极易受邪气侵袭,基于“风气百疾”理论,李师将壮儿散,即张仲景之薯蓣丸加减运用于NS缓解期肺脾肾虚证患儿,达到增强患儿体质、减少外感次数、延长缓解期、预防复发的目的。现基于该理论辨儿童NS复发的核心病机,论其特色治法,为临床治疗提供参考。

药物罐疗法在气阴两虚型肺癌患者中的应用效果

目的探讨药物罐疗法在气阴两虚型肺癌患者中的应用效果。方法选取2022年10月—2023年6月江苏省中医院收治的80例气阴两虚型肺癌患者作为研究对象,应用随机数表法将其分为观察组与对照组,每组40例。对照组采取常规干预,观察组在对照组基础上增加药物罐疗法。对比两组中医证候积分,疼痛数字评分法(NRS)评分,血液流变学,以及癌因性疲乏程度与生存质量。结果干预前两组患者主症、次症相关中医证候积分对比,差异无统计学意义(P>0.05),干预后两组患者主症、次症相关中医证候积分均降低,且观察组低于对照组(P<0.05);干预前两组患者NRS评分对比,差异无统计学意义(P>0.05),干预后两组患者评分均降低,且观察组低于对照组(P<0.05);干预前两组血液流变学指标对比,差异无统计学意义(P>0.05),干预后两组血浆比粘度、高切全血比粘度、低切全血比粘度均降低,且观察组低于对照组(P<0.05);干预前两组患者PFS-R、WHOQOL-BREF评分对比,差异无统计学意义(P>0.05),干预后两组患者PFS-R评分均降低,且观察组低于对照组,WHOQOL-BREF评分升高,且观察组高于对照组(P<0.05)。结论药物罐疗法可改善气阴两虚型肺癌患者中医症状,减轻癌因性疼痛程度,改善血液流变学水平,减轻癌因性疲乏程度,提升患者生存质量。