Magnetic resonance imaging evaluation and nuclear receptor binding SET domain protein 1 mutation in the Sotos syndrome with attention-deficit/hyperactivity disorder

Sotos syndrome is characterized by overgrowth features and is caused by alterations in the nuclear receptor binding SET domain protein 1 gene.Attentiondeficit/hyperactivity disorder(ADHD)is considered a neurodevelopment and psychiatric disorder in childhood.Genetic characteristics and clinical presentation could play an important role in the diagnosis of Sotos syndrome and ADHD.Magnetic resonance imaging(MRI)has been used to assess medical images in Sotos syndrome and ADHD.The images process is considered to display in MRI while wavelet fusion has been used to integrate distinct images for achieving more complete information in single image in this editorial.In the future,genetic mechanisms and artificial intelligence related to medical images could be used in the clinical diagnosis of Sotos syndrome and ADHD.

Clinical and genetic characteristics of a child with Sotos syndrome and attention-deficit/hyperactivity disorder:A case report

BACKGROUND Sotos syndrome is an autosomal dominant disorder,whereas attention-deficit/hyperactivity disorder(ADHD)is a neurodevelopmental condition.This report aimed to summarize the clinical and genetic features of a pediatric case of Soros syndrome and ADHD in a child exhibiting precocious puberty.CASE SUMMARY The patient presented with accelerated growth and advanced skeletal maturation;however,she lacked any distinct facial characteristics related to specific genetic disorders.Genetic analyses revealed a paternally inherited heterozygous synonymous mutation[c.4605C>T(p.Arg1535Arg)].Functional analyses suggested that this mutation may disrupt splicing,and bioinformatics analyses predicted that this mutation was likely pathogenic.After an initial diagnosis of Sotos syndrome,the patient was diagnosed with ADHD during the follow-up period at the age of 8 years and 7 months.CONCLUSION The potential for comorbid ADHD in Sotos syndrome patients should be considered to avoid the risk of a missed diagnosis.

Tourette syndrome associated with attention deficit hyperactivity disorder: The impact of tics and psychopharmacological treatment options

Tourette syndrome(TS) is a neurodevelopmental disorder characterized by multiple chronic motor and vocal tics beginning in childhood. Several studies describe the association between TS and attention deficit hyperactivity disorder(ADHD). Fifty percent of children diagnosed with ADHD have comorbid tic disorder. ADHD related symptoms have been reported in 35% to 90% of children with TS. Since ADHD is the most prevalent comorbid condition with TS and those with concomitant TS and ADHD present with considerable psychosocial and behavioral impairments, it is essential for clinicians to be familiar with these diagnoses and their management. This paper highlights the association between treating ADHD with stimulants and the development of tic disorders. The two cases discussed underscore the fact that children with TS may present with ADHD symptomatology prior to the appearance of any TS related symptoms. Appropriate management of TS in a patient diagnosed with ADHD can lead to quality of life improvements and a reduction in psychosocial impairments.

Explore the direct and/or the synergistic antihypertensive effects of wind-dispelling herbs involving Fangfeng and Baizhi on hypertensive rats with liver-yang hyperactivity based on vasoactive substances

Objective： To explore the direct and/or the enhancing antihypertensive effects of wind-dispelling herbs involvingFangfeng （Saposhnikoviae Radix） and Baizhi （Angelicae dahuricae Radix） using liver-yang hyperactivity renalhypertension rat. Methods： Model rats with hyperactivity of liver-yang hyperactivity were prepared using male SD rats.Once successful, the rats were randomly divided into groups and given medicine by gavage for 4 weeks. Blood wascollected from the abdominal aorta to prepare serum. Serum nitric oxide （NO） concentration was determined bychemical colorimetry. The contents of ET, TXB2 and 6-K-PGF1a were determined by enzyme linked immunosorbentassay （ELISA）. Results： Compared with the control model group, the blood pressure, serum ET and TXB2 of rats in thewind dispelling medicine group was not significantly reduced, while those of rats in captopril group, Tianma GoutengDecoction I group （TGD group） decreased significantly （P 〈0.05 for both）. Interestingly, the blood pressure, serum ETand TXB2 of rats in the combination group （wind dispelling medicine ＆ TGD） decreased significantly compared withboth wind dispelling medicine group and TGD group. Meanwhile, the levels of serum NO and 6- K-PGF1a in thecombination group was much higher than those in the wind dispelling medicine group or TGD group （P 〈0.05 for both）.However, the levels of serum NO and 6- K-PGF1a in the wind dispelling medicine group was not significantly increasedcompared with the model group. Conclusion： There is no direct pressure lowering effects of wind dispelling medicinealone, while wind dispelling medicine could potentiates the antihypertensive effects of Tianma Gouteng Decoction I.Besides, the synergistic effects may be related to decreased ET and TXB2 levels and the increased NO and 6- K-PGF1alevels.

Review of the evidence for the management of co-morbid Tic disorders in children and adolescents with attention deficit hyperactivity disorder

Attention deficit hyperactivity disorder(ADHD) is the most common neurodevelopmental disorder in children and adolescents, with prevalence ranging between 5% and 12% in the developed countries. Tic disorders(TD) are common co-morbidities in paediatric ADHD patients with or without pharmacotherapy treatment. There has been conflicting evidence of the role of psychostimulants in either precipitating or exacerbating TDs in ADHD patients. We carried out a literature review relating to the management of TDs in children and adolescents with ADHD through a comprehensive search of MEDLINE, EMBASE, CINAHL and Cochrane databases. No quantitative synthesis(meta-analysis) was deemed appropriate. Metaanalysis of controlled trials does not support an association between new onset or worsening of tics and normal doses of psychostimulant use. Supratherapeutic doses of dextroamphetamine have been shown to exacerbate TD. Most tics are mild or moderate and respond to psychoeducation and behavioural management. Level A evidence support the use of alpha adrenergic agonists, including Clonidine and Guanfacine, reuptake noradrenenaline inhibitors(Atomoxetine) and stimulants(Methylphenidate and Dexamphetamines) for the treatment of Tics and comorbid ADHD. Priority should be given to the management of co-morbid Tourette's syndrome(TS) or severely disabling tics in children and adolescents with ADHD. Severe TDs may require antipsychotic treatment. Antipsychotics, especially Aripiprazole, are safe and effective treatment for TS or severe Tics, but they only moderately control the co-occurring ADHD symptomatology. Short vignettes of different common clinical scenarios are presented to help clinicians determine the most appropriate treatment to consider in each patient presenting with ADHD and co-morbid TDs.

Clinical observation of Tuina plus electroacupuncture for migraine due to liver-Yang hyperactivity

Objective: To observe the clinical efficacy of Tuina (Chinese therapeutic massage) plus electroacupuncture in treating migraine due to liver-Yang hyperactivity and the effects on the serum levels of calcitonin gene-related peptide (CGRP) and prostaglandin (PG) E_(2). Methods: A total of 122 patients with migraine due to liver-Yang hyperactivity were recruited and randomized into a control group and an observation group, each consisting of 61 cases. The control group was given Tong Nao Huo Luo acupuncture (acupuncture treatment for unblocking brain collaterals), and the observation group was Tuina treatment focusing on cervical Ashi points in addition to the intervention received by the control group. Both groups were treated once daily for 21 consecutive days. When the intervention finished, the two groups were observed for changes in the headache score, symptom and sign scores of traditional Chinese medicine (TCM), the severity of impact on life, and serum CGRP and PGE_(2) levels. The clinical efficacy was compared after 21 d of treatment. Results: The observation group had a higher total effective rate than the control group, 90.2% versus 73.8% (P<0.05);after treatment, the headache and TCM symptom and sign scores decreased in both groups (P<0.05) and were lower in the observation group than in the control group (P<0.05);the migraine’s impact on life was less severe in the observation group than in the control group (P<0.05);the levels of serum CGRP and PGE_(2) dropped in the two groups (P<0.05) and were lower in the observation group (P<0.05). Conclusion: Tong Nao Huo Luo acupuncture can produce more significant efficacy in treating migraine due to liver-Yang hyperactivity when combined with cervical Tuina at Ashi points, better alleviating the headache, improving TCM symptoms and body signs, and reducing the impact of headache on life. The mechanism may be associated with inhibiting the expression of serum pain factors CGRP and PGE_(2).

Systematic review and meta analysis of randomized controlled trials on Tianmagouteng decoction in treatment of primary hypertension with liverYang hyperactivity syndrome

OBJECTIVE： To assess the efficacy of Tianma- gouteng decoction in the treatment of primary hypertension with liver yang hyperactivity syndrome. METHODS： The databases of MEDLINE （1950- 2012）, EMbase （1980-2012）, China biology medicine （CBM） （1994-2012）, China national knowledge infrastructure （CNKI） （1989-2012）, Weipu （VIP） （1995-2012） and Wanfang （1989-2012） were searched and we performed manual searches for conference proceedings to select randomized controlled trials （RCTs） on Tianmagouteng decoction for the treatment of primary hypertension with liver Yang hyperactivity syndrome. Studies were en- rolled according to the study-selecting criteria. The methodological quality was evaluated, data were extracted and meta-analyses were conducted with RevMan 4.2 software. RESULTS： Nine RCTs were selected involving 784 patients with no significant difference in decrease in systolic blood pressure （SBP）[0R=1.02, 9.5% CI （-0.24, 2.29）, P=0.10] and diastolic blood pressure（DBP） [OR=0.56, 95% CI （-0.10,1.23）, P=0.11] between the Tianmagouteng group and the control group. While there was a significantly larger increase in serum superoxide dismutase （SOD）[OR= 6.26, 95% CI （1.27,11.66）, P=0. 01] in the Tianmagouteng group than that in the control group CONCLUSION： Tianmagouteng decoction can decrease both systolic and diastolic blood pressure and greatly increase serum SOD. Due to poor quality of included studies, the efficacy needs to be further assessed.

Study on the Biological Basis of Hypertension and Syndrome with Liver-Fire Hyperactivity Based on Data Mining Technology

Objective: To construct gene co-occurrence network of hypertension and liver-fire hyperactivity syndrome, to investigate the biological basis of hypertension and liver-fire hyperactivity syndrome and the characteristics of the molecular network from gene level.Materials and Methods: Applying Gen CLip 2.0 online platform to retrieve the up-to-date literature referred to essential hypertension from PubMed database, cluster the abnormal expression of essential hypertension-related genes and analyze their function, combining Kyoto encyclopedia of genes and genomes-pathway analysis to investigate the closely related genes and the signaling molecules.Based on the genes closely related to hypertension, standard diagnostic symptoms of liver-fire hyperactivity were used as keywords to conduct hypertension liver-fire hyperactivity-related gene cluster analysis.Results: The top 1000 genes of essential hypertension were retrieved from GenCLip 2.0 online platform, which mainly clustered in the regulation of ambulatory blood pressure, regulation of renin-angiotensin-aldosterone system(RAAS), and sympathetic nervous system activity, as well as endothelial dysfunction; the closely related genes of hypertension with liver-fire hyperactivity are related to RAAS, gene REN, angiotensin converting enzyme, angiotensinogen, and cytochrome P450 family CYP2D6.Conclusion: A combination of literature mining and data mining can construct the gene network of hypertension and the syndrome-related genes, which provides a new method for the study of the biological basis of hypertension from the genetic level.

正常高值血压肝火亢盛证与血浆同型半胱氨酸的相关性研究

目的探讨正常高值血压肝火亢盛证与同型半胱氨酸相关性及其化验指标的关系。方法选取2016年11月—2019年11月期间山东中医药大学附属医院心病科就诊及体检人群正常高值血压肝火亢盛证患者84例,同时选取同期就诊的理想血压人群53例、高血压肝火亢盛证人群52例,受试者进行一般检查(身高、体质量、血压、静息心率),血浆同型半胱氨酸(Homocysteine,Hcy)、生化指标、尿微量白蛋白检测。结果正常高值血压肝火亢盛证组中血清高同型半胱氨酸(Hyper homocysteine,HHcy)检出率为7.14%,高血压肝火亢盛证组中血清高同型半胱氨酸检出率为76.92%,呈递增趋势。正常高值血压肝火亢盛证组尿微量白蛋白阳性检出率为1.92%,高血压肝火亢盛证组尿微量白蛋白阳性检出率为10.81%,呈递增趋势。LSD-t检验结果可知Hcy在正常血压组与高血压肝火亢盛证组及正常高值血压肝火亢盛证组与高血压肝火亢盛证组之间,差别有统计学意义(P<0.05);总胆固醇在正常血压与正常高值血压之间,差别有统计学意义(P<0.05);低密度脂蛋白胆固醇(Low-density lipoprotein cholesterol,LDL-C)在正常血压与正常高值血压之间,差别有统计学意义(P<0.05)。对正常高值血压肝火亢盛证组同型半胱氨酸值行pearson相关分析,结果显示,同型半胱氨酸与血清尿酸、血清肌酐具有相关性(P<0.05)。结论在正常高值血压肝火亢盛证人群中同型半胱氨酸升高,且同型半胱氨酸与血清尿酸、血清肌酐具有相关性。

基于数据挖掘王晓燕教授治疗儿童抽动障碍脾虚肝亢证用药规律

目的运用数据挖掘技术分析并总结王晓燕教授治疗儿童抽动障碍脾虚肝亢证的用药经验。方法收集王教授门诊治疗的脾虚肝亢证抽动障碍患儿,运用中医传承辅助平台(V 2.5)建立数据库,对数据库中处方予频次分析、关联规则分析和复杂系统熵聚分析。结果共收集122首方,涉及中药64味,用药频次前11位分别为麸炒白术、麸炒苍术、炙甘草、炒白芍、蝉蜕、柴胡、陈皮、炒莱菔子、炒酸枣仁、炒僵蚕、珍珠母。药物四气以温寒药居多,五味以苦辛甘为主,归经以肝脾肺居多。药物组合频次超过115次的共30组。得到潜在核心组合6组,潜在新方3首。结论王教授治疗儿童抽动障碍脾虚肝亢证用药以寒温并举,辛苦兼施为主,主张肝脾同调,土木并举,选用自拟方柴术调肝理脾汤为基础加减治疗。

清火消痈汤治疗心肝火旺及热毒内蕴型肺痈临床观察

目的研究清火消痈汤治疗心肝火旺及热毒内蕴型肺痈的临床价值。方法以2021年1月—2021年12月为研究周期,抽取研究对象72例,采用随机数字表法分为研究组、对照组,各36例;对照组予西药治疗,研究组予清火消痈汤治疗,对比两组呼吸功能指标和中医证候积分。结果治疗后,研究组二氧化碳分压(PaCO_(2))水平为(41.42±3.75)mm Hg(1 mm Hg≈0.133 kPa),低于对照组的(47.59±5.88)mm Hg(P<0.05);氧分压(PaO_(2))水平为(82.99±6.75)mm Hg,高于对照组的(73.26±2.48)mm Hg(P<0.05)。治疗后,研究组主证积分为(2.44±0.68)分、次证积分为(0.65±0.11)分、总积分为(3.12±0.64)分,均低于对照组的(5.29±1.05)分、(1.89±0.62)分、(7.28±1.75)分(P<0.05)。结论清火消痈汤治疗肺痈效果显著。

中药穴位贴敷联合耳穴压豆对阴虚阳亢型老年高血压合并衰弱的临床观察

目的探讨中药穴位贴敷联合耳穴压豆对阴虚阳亢型老年高血压合并衰弱的临床效果,为老年高血压合并衰弱患者的防治提供借鉴。方法选取2023年3—11月医院收治的60例阴虚阳亢型老年高血压合并衰弱患者作为研究对象,按照组间基线资料具有可比性的原则分为对照组和观察组,各30例。对照组给予常规降血压护理和健康教育,宣教2周,每周1次,共宣教2次;观察组在对照组基础上采用中药穴位贴敷联合耳穴压豆治疗,每天1次,1周为1疗程,共干预2周。2周结束后,比较两组患者干预后的临床效果。干预前、干预2周后采用电子血压计、中医证候积分量表、老年人衰弱评估量表评估两组患者的收缩压(SBP)、舒张压(DBP)、中医证候积分及老年衰弱评分的改善程度。结果干预前,两组患者血压、中医证候积分、老年衰弱评分比较,差异无统计学意义(P>0.05);干预后,观察组患者在血压、中医证候积分、老年衰弱评分均低于对照组,差异具有统计学意义(P<0.05)。干预后,观察组降压效果优于对照组,两组间比较差异有统计学意义(P<0.05)。结论对阴虚阳亢型老年高血压合并衰弱患者进行中药穴位贴敷和耳穴压豆,根据其证型选穴贴压肝、肾、交感、神门、降压沟、皮质下、胆、心八大穴位,其效果良好,操作简便,无不良反应发生,可有效改善患者血压、中医证候及衰弱症状,促进患者康复。

从痉证论治阵发性交感神经过度兴奋综合征

阵发性交感神经过度兴奋综合征(PSH)是一种与中重度脑损伤相关的临床综合征,以同时发生的肌张力障碍及交感神经功能亢进为临床表现。目前针对PSH的临床治疗侧重于西医对症处理,中医整体观念与辨证论治思维可以兼顾多证,能够对西医治疗进行有效补充。通过临床观察发现,在西药对症治疗基础上联合中药及针灸等中医疗法有助于提高疗效,减少不良反应,同时缩短病程。但由于从发现到逐步认识PSH的时间较短,因此对其病位、病因、病机、分型及中医治疗尚无系统认识。PSH发作时的肌张力障碍表现为四肢肌张力高、角弓反张等,发作表现符合中医痉证范畴,故文章试从痉证论述PSH的中医辨治,以期为PSH的中医治疗提供理论基础。

平肝头痛汤联合西药治疗偏头痛(肝阳上亢证)临床观察

目的观察平肝头痛汤对偏头痛(肝阳上亢证)患者的临床疗效。方法将偏头痛患者64例随机分为两组各32例。其中试验组给予平肝头痛汤联合盐酸氟桂利嗪胶囊,对照组给予盐酸氟桂利嗪胶囊,共治疗4周。比较两组患者中医证候积分、头痛计分法量化评分、HIT-6头痛影响评分的变化及临床总有效率。结果试验组头痛积分疗效、中医证候积分总有效率均为96.88%,分别高于对照组的84.38%、78.13%(P<0.05);两组治疗后头痛计分法量化评分、中医证候积分、HIT-6头痛影响评分均较治疗前降低(P<0.05),且试验组均低于对照组(P<0.05)。结论平肝头痛汤对偏头痛(肝阳上亢证)患者具有较好的临床疗效,能够显著减轻患者症状,并改善患者整体健康状况。

抽动障碍肝阳上亢证病证结合大鼠模型的对比研究

目的构建亚氨基二丙腈(iminodiProPion-itri,IDPN)、2,5-二甲氧-4-碘苯-2-氨基丙烷(5-dimethoxy-4-uodoPhenyl-2-aminoProPan,DOI)、阿扑吗啡(aPomorPhine,APO)3种抽动障碍(tic disorder,TD)大鼠模型对其行为特征、激惹状态及相关递质变化进行比较;选择表观效度及结构效度良好的TD模型分别加载不同应激刺激,构建、评价及筛选最优TD肝阳上亢证病证结合大鼠模型。方法120只SD大鼠随机分为6组:对照组正常饲喂,不做特殊处理;IDPN组腹腔注射IDPN溶液持续1周;DOI组、APO组分别腹腔注射DOI溶液、APO溶液持续2周;APO复合束缚悬吊应激(restraint and suspension stress,RSS)模型组(APO+RSS组)腹腔注射APO溶液2周同时复合慢性束缚悬吊应激持续3周;APO复合声电刺激应激(acoustic and electrical stimulation stress,AESS)模型组(APO+AESS组)腹腔注射APO溶液2周同时复合声电刺激应激持续3周。通过行为学实验评估大鼠刻板运动、自发活动及情绪障碍;酶联免疫吸附测定(enzyme linked immunosorbent assay,ELISA)法测定纹状体中多巴胺(dopamine,DA)、γ-氨基丁酸(γ-aminobutyric acid,GABA)、谷氨酸(glutamate,GLU)、五羟色胺(serotonin,5-HT)水平变化,血清中血管紧张素II(Angiotensin II,AngⅡ)、精氨酸加压素(arginine vasopressin,AVP)水平变化。结果APO、DOI、IDPN诱导造模结果显示,与对照组比较,3种造模方式均可成功诱导大鼠的自发活动、刻板运动、认知及情绪障碍。IDPN组表现为更明显的刻板运动、认知障碍及焦虑抑郁倾向,与对照组相比DA、GLU水平降低(P<0.05),5-HT水平升高(P<0.05);APO组表现为更明显的自发活动及兴奋、易激惹状态、探索及攻击行为增多,与对照组相比DA、GLU水平升高(P<0.05),AngⅡ水平显著升高(P<0.01);DOI组大鼠行为学表现与APO组相似,但自发活动、刻板运动程度较APO组差;与对照组相比DOI组5-HT水平显著降低(P<0.01)。APO加载复合模型比较结果显示,APO+RSS组大鼠自发活动、刻板运动、探索行为较APO组增加;APO+AESS组表现为更明显的认知障碍。APO+RSS组大鼠纹状体DA、GLU水平、血清AngⅡ较APO组、APO+AESS组增加(P<0.05)。结论APO诱导TD模型表观效度及结构效度良好,并在一定程度上具备中医肝阳上亢证特点;APO复合束缚悬吊应激刺激模型激活RAS系统加重肝阳上亢症状并有利于维持TD模型稳定,是较为理想的TD肝阳上亢证病证结合动物模型。

穴位贴敷治疗原发性高血压(1级)临床研究

目的:研究穴位贴敷治疗原发性高血压(1级)的临床疗效和安全性,为临床治疗高血压提供客观、有效的循证证据。方法:采用随机、双盲、安慰剂对照、多中心临床研究的方法,选取山东省6家医院收治的原发性高血压(1级)患者174例作为研究对象,分为观察组和对照组各87例。观察组采用穴位贴敷,选择白芥子、钩藤贴敷大椎穴,吴茱萸、川芎贴敷神阙穴,吴茱萸、冰片贴敷涌泉穴,贴敷4周。对照组采用安慰中药穴位贴敷。比较两组治疗前后的诊室血压、中医证候积分、杜氏高血压生活质量量表积分、肾素-血管紧张素-醛固酮系统以及血、尿儿茶酚胺水平等指标。结果:治疗4周后,两组收缩压和舒张压均降低,且观察组低于对照组(P<0.01);观察组降压幅度高于对照组(P<0.01),观察组降压总有效率为85.1%,对照组60.9%,观察组降压疗效优于本组治疗前及对照组(P<0.01);观察组中医证候积分、杜氏高血压生活质量量表积分均优于对照组(P<0.05)。观察组血管紧张素Ⅱ、醛固酮以及血去甲肾上腺素的水平均低于本组治疗前及对照组(P<0.05);两组均未见明显不良反应。结论:穴位贴敷疗法能显著降低原发性高血压(1级)阴虚阳亢证患者的收缩压和舒张压,改善中医证候和生活质量,且安全性较好。

创伤性脑损伤后阵发性交感神经过度兴奋综合征的研究进展

阵发性交感神经过度兴奋综合征(PSH)是中重度创伤性脑损伤(TBI)后一种常见的并发症,以同时、阵发性的交感神经兴奋性增加(高热、血压升高、心率增快、呼吸急促、大汗)和姿势或肌张力障碍为特征。PSH的临床表现存在个体差异,症状缺乏特异性,早期易与脓毒症、癫痫等疾病相混淆。目前PSH的发病机制尚未明确,诊断主要通过临床表现及排除其他疾病,因此易造成误诊及治疗延迟,最终阻碍TBI患者的康复过程。本文就创伤性脑损伤后PSH的临床特点、发病机制、诊断、治疗等进行综述,以期为PSH的早期诊断、治疗提供指导。

关于阴虚阳亢型丑时不寐患者的临床观察

目的 旨在探讨阴虚阳亢型丑时不寐患者的临床特征。方法 选取90例以丑时易醒、醒后持续半小时以上不能入睡为主要特征的阴虚阳亢证不寐患者,对患者基线资料、安全性指标、PSQI分值、证候积分、血压水平进行资料收集,分析各因素对阴虚阳亢型丑时不寐患者睡眠、血压的影响。结果 吸烟史、饮酒史、脑血管病史与PSQI分值存在相关性(P<0.05);收缩压水平与PSQI分值存在相关性(P<0.05);舒张压水平与PSQI分值存在显著相关性(P<0.01)。性别对丑时不寐患者的舒张压水平有影响,男性高于女性(P<0.05);年龄对丑时不寐患者的收缩压水平有影响,≤60周岁患者的收缩压水平高于> 60周岁患者;存在吸烟史的丑时不寐患者的收缩压、舒张压、脉压差水平均高于没有吸烟史的患者(P<0.05);存在饮酒史的丑时不寐患者的收缩压、舒张压水平均高于没有饮酒史的患者(P<0.05);存在脑血管病史的丑时不寐患者的的收缩压、舒张压、脉压差水平均高于没有脑血管病史的患者(P<0.05)。结论 阴虚阳亢型丑时不寐患者中,以男性、中青年居多,既往吸烟史饮酒史、脑血管病史居多,病程3个月~1年者居多,入组患者以丑时易醒,醒后难以入睡为主要特征,大多数患者伴有盗汗、呼吸不畅;吸烟、饮酒、脑血管病以及收缩压、舒张压水平异常均会导致丑时不寐的发生或加重;性别、年龄、吸烟史、饮酒史、脑血管病史与丑时不寐患者的血压水平密切相关。

天麻降压胶囊治疗H型高血压肝火亢盛证的临床效果及对同型半胱氨酸、超敏C反应蛋白的影响

目的观察天麻降压胶囊治疗H型高血压(肝火亢盛证)的临床效果及对同型半胱氨酸(Hcy)、超敏C反应蛋白(hs-CRP)的影响。方法选取2021年5月至2022年12月天水市中医医院就诊的165例轻、中度H型高血压(肝火亢盛证)患者作为研究对象,按照随机数字表法将其分为对照组(83例)和治疗组(82例)。对照组予以马来酸依那普利叶酸片治疗,治疗组在对照组基础上加服天麻降压胶囊治疗,两组均治疗3个月。比较治疗前后两组患者的收缩压、舒张压、Hcy、hs-CRP水平及中医证候积分的情况,并判断血压疗效及中医疗效。结果治疗后,两组患者的收缩压与舒张压均低于本组治疗前,且治疗组的收缩压与舒张压均低于对照组,差异有统计学意义(P<0.05);治疗组的血压总有效率(97.56%)高于对照组(86.75%),差异有统计学意义(P<0.05)。治疗后,两组患者的Hcy、hs-CRP水平及中医证候总积分均低于本组治疗前,且治疗组的Hcy、hs-CRP水平及中医证候总积分均低于对照组,差异有统计学意义(P<0.05);治疗组的中医治疗总有效率(85.37%)高于对照组(73.49%),差异有统计学意义(P<0.05)。结论天麻降压胶囊治疗H型高血压(肝火亢盛证)具有较好的临床疗效,可显著改善患者症状,降低Hcy、hs-CRP水平,值得进一步推广应用。

从《伤寒论》少阴篇讨论阳虚阴盛证辨治规律

[目的]讨论《伤寒论》中阳虚阴盛证的病势、层次、治法及用药规律,探究并扩充阳虚阴盛证的辨治规律及临床意义。[方法]结合后世医家的医论,明确阳虚阴盛证的病机及证候;从病理生理学角度,阐释阳虚阴盛证的机制;分析少阴篇中各版本条文的差异,论述病位、邪气性质、胃气、津液的不同,治法、主方、配伍的变化,归纳在少阴篇中隐含的辨治规律。[结果]阳虚阴盛证的辨治原则是“保胃气、存津液”,可将其细分为太阴湿土病、少阴君火病、厥阴风木病。细致的望闻问切,并结合现代医学的病理生理基础能精确辨阳虚阴盛证。少阴为三阴枢机,少阴篇结构完整,能动态反映少阴发病、两阴合病或并病、三阴合病的相互变化过程。由条文可发现,病位由表入里,治法有灸焫、温经、温阳、通阳之别;病情由轻而重、痰饮有无,治法有散寒、散饮、利水之别;津液损伤程度不同,治法有救逆、救阴之别。[结论]从病理生理角度,能阐释中医主症的变化机制。辨治阳虚阴盛证时,应根据病位、邪气性质、胃气、津液择取方药,阳虚阴盛证的辨治规律对于其他证候的辨治同样具有指导意义。